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General NPI Number Information
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NPI Number | 1689951014
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Entity Type | Individual
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Provider Name | LAUREN RAE MACKIE CNP
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Gender | Female
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Dates
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Enumeration Date | 11/14/2011
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 2600 6TH ST SW
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City | CANTON
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State | OH
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Zip | 44710-1702
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Country | US
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Telephone | 330-363-6281
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Fax |
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Provider Business Mailing Address
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Address Line | 6133 SLAVIN CIR NW
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City | CANAL FULTON
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State | OH
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Zip | 44614-8227
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Country | US
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Telephone | 330-704-4453
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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 | COA.12806-NP
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License Number State | OH
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