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General NPI Number Information
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NPI Number | 1932225794
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Entity Type | Individual
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Provider Name | MARY JO M MACKINNON FNP-C, ND
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Gender | Female
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 12/04/2018
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Provider Practice Location Address
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Address Line | 8 ABBOTT PARK PL
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City | PROVIDENCE
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State | RI
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Zip | 02903-3703
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Country | US
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Telephone | 401-598-1104
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Fax |
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Provider Business Mailing Address
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Address Line | 68 WOOD COVE DR
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City | COVENTRY
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State | RI
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Zip | 02816-6611
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Country | US
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Telephone | 303-981-4407
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 259166
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN00581
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License Number State | RI
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