Healthcare Provider Details

I. General information

NPI: 1154434124
Provider Name (Legal Business Name): MAUREEN E MACKEY MD CHARTERED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 ALMOND TREE LN SUITE 201
LAS VEGAS NV
89104-3229
US

IV. Provider business mailing address

1120 ALMOND TREE LN SUITE 201
LAS VEGAS NV
89104-3229
US

V. Phone/Fax

Practice location:
  • Phone: 702-650-3390
  • Fax: 702-650-5864
Mailing address:
  • Phone: 702-650-3390
  • Fax: 702-650-5864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number4200
License Number StateNV

VIII. Authorized Official

Name: DR. MAUREEN E MACKEY
Title or Position: CEO
Credential: MD
Phone: 702-650-3390