Basic Information
| Provider Information | |||||||||
| NPI: | 1568633584 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDONNELL | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSN PMH-NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 NW HAWTHORNE AVE | ||||||||
| Address2: | |||||||||
| City: | GRANTS PASS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975261400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414173455 | ||||||||
| FaxNumber: | 5414711439 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 NW HAWTHORNE AVE | ||||||||
| Address2: | |||||||||
| City: | GRANTS PASS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975261400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414173455 | ||||||||
| FaxNumber: | 5414711439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2008 | ||||||||
| LastUpdateDate: | 03/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0807X | RN 732662 | CA | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Child & Adolescent | 163WP0808X | 041330155 | IL | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 163WP0808X | 200943049RN | OR | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 163WP0809X | RN 732662 | CA | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult | 363LP0808X | NP 18356 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | 200950161NP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.