Basic Information
Provider Information
NPI: 1376054841
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCDONALD-NIXON
FirstName: SERENA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 490 N GRAPE ST
Address2:  
City: ESCONDIDO
State: CA
PostalCode: 920253079
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 490 N GRAPE ST
Address2:  
City: ESCONDIDO
State: CA
PostalCode: 920253079
CountryCode: US
TelephoneNumber: 6192750822
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/23/2017
LastUpdateDate: 10/23/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
164X00000X290439CAY Nursing Service ProvidersLicensed Vocational Nurse 

No ID Information.


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