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General NPI Number Information
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NPI Number | 1598068520
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Entity Type | Individual
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Provider Name | JAMES HOWARD MACKEY III CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/14/2010
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Last Update Date | 10/25/2017
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Provider Practice Location Address
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Address Line | 50 UNION ST
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City | ELLSWORTH
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State | ME
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Zip | 04605-1534
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Country | US
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Telephone | 207-664-5311
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Fax | 207-664-5305
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Provider Business Mailing Address
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Address Line | 610 BALTIMORE ST POBOX 329
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City | CHARLESTOWN
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State | MD
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Zip | 21914-1103
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Country | US
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Telephone | 410-287-9616
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R138984
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License Number State | MD
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