Healthcare Provider Details

I. General information

NPI: 1639362023
Provider Name (Legal Business Name): CYNTHIA A MACKLIN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N CHELAN AVE
WENATCHEE WA
98801-6697
US

IV. Provider business mailing address

820 N CHELAN AVE
WENATCHEE WA
98801-2028
US

V. Phone/Fax

Practice location:
  • Phone: 509-662-1511
  • Fax:
Mailing address:
  • Phone: 509-662-1511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA60221857
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60221857
License Number StateWA

VII. Legacy identifiers

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

# 1
IdentifierGAB23289
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerPTAN
# 2
IdentifierG8903574
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerPTA#

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: