Healthcare Provider Details

I. General information

NPI: 1396315545
Provider Name (Legal Business Name): ROSEMARY MACKEY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4697 HARRISON ST
BELLAIRE OH
43906-1338
US

IV. Provider business mailing address

2363 LUMBER AVE
WHEELING WV
26003-5381
US

V. Phone/Fax

Practice location:
  • Phone: 740-968-7006
  • Fax:
Mailing address:
  • Phone: 304-231-7556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number312799
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: