Provider Demographics
NPI:1427177518
Name:MACKNET, JAMIE CHEREE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:CHEREE
Last Name:MACKNET
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:512 LANTERN CREST DR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7281
Mailing Address - Country:US
Mailing Address - Phone:909-799-0546
Mailing Address - Fax:866-856-0338
Practice Address - Street 1:25815 BARTON RD STE 103
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3894
Practice Address - Country:US
Practice Address - Phone:909-799-8620
Practice Address - Fax:877-821-6331
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540481163WR0006X, 163WW0101X, 163WX0002X
CANP15300363L00000X, 363LA2200X, 363LA2100X
CACNS2140364S00000X, 364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP 15300OtherNURSE PRACTITIONER LICENSE
CANP 15300OtherNURSE PRACTITIONER LICENSE
MM2129600OtherDEA