Provider Demographics
NPI:1023649746
Name:MCDONALD, OLIVIA
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 W 15TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2416
Mailing Address - Country:US
Mailing Address - Phone:985-338-2596
Mailing Address - Fax:985-893-3737
Practice Address - Street 1:706 W 15TH AVE STE A
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2416
Practice Address - Country:US
Practice Address - Phone:985-338-2596
Practice Address - Fax:985-893-3737
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA211469363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily