Healthcare Provider Details

I. General information

NPI: 1770110645
Provider Name (Legal Business Name): MACKENZIE CLAIRE RINALDI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MACKENZIE CLAIRE JOHNSON MD

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 SE PROFESSIONAL MALL BLVD STE 104
PULLMAN WA
99163-5423
US

IV. Provider business mailing address

1205 SE PROFESSIONAL MALL BLVD STE 104
PULLMAN WA
99163-5423
US

V. Phone/Fax

Practice location:
  • Phone: 509-332-2605
  • Fax: 509-715-2123
Mailing address:
  • Phone: 509-332-2605
  • Fax: 509-715-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM17298
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD61423154
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2257556
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: