Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 164567 | MA |
NPI | 1003110131 |
---|---|
Provider Name | Mrs. Barbara Charlene Mackey |
First Address | Tewkbury, MA 01876-3221 |
Second Address | Quincy, MA 02169-4721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2011 |
Last Update Date | 04/01/2011 |