Individual
MRS. STEPHANIE PIKE MCDONALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
680 GUZZI LN STE 105, SONORA, CA 95370-5288
(209) 532-0126
(209) 532-2950
Mailing address
13005 COVEY CIR, SONORA, CA 95370-6934
(209) 532-0126
(209) 532-2950
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
10000970A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000556059
ANTHEM
IN
Enumeration date
12/05/2007
Last updated
10/23/2013
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