Provider Demographics
NPI:1871973008
Name:MACDONALD, BETTY
Entity type:Individual
Prefix:MS
First Name:BETTY
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BETTY
Other - Middle Name:ELAINE
Other - Last Name:MACDONALD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-0208
Mailing Address - Country:US
Mailing Address - Phone:207-794-2001
Mailing Address - Fax:207-794-2076
Practice Address - Street 1:313 ENFIELD ROAD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-0208
Practice Address - Country:US
Practice Address - Phone:207-794-2001
Practice Address - Fax:207-794-2076
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME50661163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse