Basic Information
| Provider Information | |||||||||
| NPI: | 1033665278 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACKEY | ||||||||
| FirstName: | ELISABETH | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 714 W PINE ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 991569046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094479363 | ||||||||
| FaxNumber: | 5094470456 | ||||||||
| Practice Location | |||||||||
| Address1: | 704 WEST PINE STREET | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094476028 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2016 | ||||||||
| LastUpdateDate: | 09/07/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | AP60684756 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.