Basic Information
| Provider Information | |||||||||
| NPI: | 1538384383 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDONALD | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | KATHRYN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8085 RIVERS AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | NORTH CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294069239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436282529 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 MARIS GROVE WAY | ||||||||
| Address2: | |||||||||
| City: | GLEN MILLS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193421282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103874520 | ||||||||
| FaxNumber: | 6103874526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | SP008919 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.