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General NPI Number Information
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NPI Number | 1730816810
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Entity Type | Organization
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Legal Business Name | MACKE FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 08/08/2022
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 1025 FAIR RD
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City | SIDNEY
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State | OH
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Zip | 45365-8947
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Country | US
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Telephone | 937-492-1352
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Fax | 937-492-1353
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Provider Business Mailing Address
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Address Line | 1025 FAIR RD
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City | SIDNEY
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State | OH
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Zip | 45365-8947
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Country | US
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Telephone | 937-492-1352
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Fax | 937-492-1353
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | DAWN DIANE MACKE
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Credential | APRN-CNP
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Telephone | 937-492-1352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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