Healthcare Provider Details

I. General information

NPI: 1053456434
Provider Name (Legal Business Name): DEANN MACKEY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S 100 W
MOUNT PLEASANT UT
84647-1507
US

IV. Provider business mailing address

675 W 40 N
MANTI UT
84642-1322
US

V. Phone/Fax

Practice location:
  • Phone: 435-462-9204
  • Fax: 435-462-9204
Mailing address:
  • Phone: 435-835-6045
  • Fax: 435-835-2231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number211234-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: