Individual
LISA L MCDONALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
16 ST EDMUNDS WAY, ELLENBURG, NY 12933-9998
(518) 594-3500
(518) 594-3035
Mailing address
16 ST EDMUNDS WAY, PO BOX 94, ELLENBURG, NY 12933-9998
(518) 594-3500
(518) 594-3035
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
370412-1
NY
363L00000X
Nurse Practitioner
Primary
F331452-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02218500
—
NY
01
—
0510G
EMPIRE BC/BS
—
Enumeration date
08/28/2006
Last updated
05/11/2016
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