Provider Demographics
NPI:1316051147
Name:MACKIE, JUDITH ARLENE (RN , FNP)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ARLENE
Last Name:MACKIE
Suffix:
Gender:F
Credentials:RN , FNP
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Mailing Address - Street 1:4324 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95824-3747
Mailing Address - Country:US
Mailing Address - Phone:916-422-9258
Mailing Address - Fax:
Practice Address - Street 1:1122 CORPORATE WAY STE 300
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-6125
Practice Address - Country:US
Practice Address - Phone:916-392-3655
Practice Address - Fax:916-488-6300
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARN 222215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily