Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DI024233 | NJ |
N | 122300000X | Dentist | DN18071 | FL |
N | 1223P0700X | Prosthodontist | 055160-1 | NY |
Y | 1223P0700X | Prosthodontist | S543C | NV |
NPI | 1205169034 |
---|---|
Provider Name | Dr. Nicole Leila Mackie |
First Address | Las Vegas, NV 89148-1355 |
Second Address | Las Vegas, NV 89148-1355 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2009 |
Last Update Date | 14/09/2021 |