Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0102206639 | VA |
NPI | 1003310590 |
---|---|
Provider Name | Dale-Marie N Mckie |
First Address | Miami Gardens, FL 33169-5710 |
Second Address | Virginia Beach, VA 23462-5629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2018 |
Last Update Date | 02/06/2021 |