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General NPI Number Information
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NPI Number | 1316051147
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Entity Type | Individual
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Provider Name | JUDITH ARLENE MACKIE RN , FNP
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Gender | Female
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 03/20/2013
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Provider Practice Location Address
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Address Line | 1122 CORPORATE WAY STE 300
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City | SACRAMENTO
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State | CA
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Zip | 95831-6125
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Country | US
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Telephone | 916-392-3655
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Fax | 916-488-6300
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Provider Business Mailing Address
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Address Line | 4324 44TH AVE
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City | SACRAMENTO
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State | CA
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Zip | 95824-3747
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Country | US
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Telephone | 916-422-9258
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN 222215
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License Number State | CA
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