Provider Demographics
NPI:1548273832
Name:GAMMIE MCDONALD, LAUREL L (CNM)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:L
Last Name:GAMMIE MCDONALD
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:1454 MADISON AVE W
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34142-2200
Mailing Address - Country:US
Mailing Address - Phone:239-658-3707
Mailing Address - Fax:239-434-2805
Practice Address - Street 1:10300 SW 216TH ST
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1003
Practice Address - Country:US
Practice Address - Phone:300-525-3510
Practice Address - Fax:305-254-4901
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2018-12-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP 1537942363L00000X
FLARNP1537942367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008593100Medicaid