MEDICARE: MICHELLE MACKINNON R.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	885727	CA

General Provider Information

NPI Number	:	1023116423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE MACKINNON R.D.

Provider Business Mailing Address
First Line	:	941 COUNTRYWOOD COURT
Second Line	:
City	:	ORCUTT
State	:	CA
Zip	:	93455-3517
Country	:	US
Telephone Number	:	805-314-2588
Fax Number	:

Provider Business Practice Location Address
First Line	:	941 COUNTRYWOOD COURT
Second Line	:
City	:	ORCUTT
State	:	CA
Zip	:	93455-3517
Country	:	US
Telephone Number	:	805-314-2588
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	09/07/2016

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Directions to “ MICHELLE MACKINNON R.D.” Practice Location

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