Healthcare Provider Details

I. General information

NPI: 1962425991
Provider Name (Legal Business Name): GAIL P MACKIN RN/NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 WESTFIELD ST
WEST SPRINGFIELD MA
01089-3878
US

IV. Provider business mailing address

186 MILL ST
RANDOLPH MA
02368-5038
US

V. Phone/Fax

Practice location:
  • Phone: 413-592-1980
  • Fax: 413-439-0096
Mailing address:
  • Phone: 781-961-6683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number123439
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: