Provider Demographics
NPI:1730765579
Name:MCDONALD, HANORAH BRIGHID (FNP AGACNP)
Entity type:Individual
Prefix:
First Name:HANORAH
Middle Name:BRIGHID
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:FNP AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:CONDON
Mailing Address - State:OR
Mailing Address - Zip Code:97823-0141
Mailing Address - Country:US
Mailing Address - Phone:541-384-2287
Mailing Address - Fax:
Practice Address - Street 1:712 JAY ST
Practice Address - Street 2:
Practice Address - City:FOSSIL
Practice Address - State:OR
Practice Address - Zip Code:97830-8371
Practice Address - Country:US
Practice Address - Phone:541-763-2725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202011101NP-PP207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR202011101NP-PPOtherFNP LICENSE
OR202011100NP-PPOtherAGACNP LICENSE