Provider Demographics
NPI:1366925281
Name:MCDONALD, MADISON MARIE
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:MARIE
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 1:7707 N FOX POINT DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6325
Mailing Address - Country:US
Mailing Address - Phone:253-302-7995
Mailing Address - Fax:
Practice Address - Street 1:910 W 5TH AVE STE 800
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2912
Practice Address - Country:US
Practice Address - Phone:509-755-5120
Practice Address - Fax:509-342-2272
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60976632363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant