Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP60684756 | WA |
NPI | 1033665278 |
---|---|
Provider Name | Elisabeth Mackey |
First Address | Newport, WA 99156-9046 |
Second Address | Newport, WA 99156 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2016 |
Last Update Date | 07/09/2016 |