Healthcare Provider Details

I. General information

NPI: 1134627227
Provider Name (Legal Business Name): ALISHA MACKIE RNFA, CNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 COLLEGE DR
ROCK SPRINGS WY
82901-5868
US

IV. Provider business mailing address

350 VIA RUCCE DR
ROCK SPRINGS WY
82901-7760
US

V. Phone/Fax

Practice location:
  • Phone: 307-362-3711
  • Fax:
Mailing address:
  • Phone: 307-389-2792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number32131
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: