Healthcare Provider Details

I. General information

NPI: 1144946468
Provider Name (Legal Business Name): CHRISTIE J MACKSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 BONNET ST
MANCHESTER CENTER VT
05255-7300
US

IV. Provider business mailing address

PO BOX 732
EAST DORSET VT
05253-0732
US

V. Phone/Fax

Practice location:
  • Phone: 908-827-6482
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404905
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number101.0135733
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: