Provider Demographics
NPI:1891510244
Name:MCDONALD, CHANTEL DYNICE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:CHANTEL
Middle Name:DYNICE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:TX
Mailing Address - Zip Code:76527-4062
Mailing Address - Country:US
Mailing Address - Phone:254-793-2497
Mailing Address - Fax:254-793-4507
Practice Address - Street 1:2790 COUNTRY ROAD 228
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:TX
Practice Address - Zip Code:76527
Practice Address - Country:US
Practice Address - Phone:254-368-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX601557163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse