MEDICARE: CATHY MACKLIN LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	LP044678	AZ

General Provider Information

NPI Number	:	1255584660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHY MACKLIN LPN

Provider Business Mailing Address
First Line	:	6602 W OSBORN RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85033-4533
Country	:	US
Telephone Number	:	623-691-4615
Fax Number	:	623-691-4620

Provider Business Practice Location Address
First Line	:	6602 W OSBORN RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85033-4533
Country	:	US
Telephone Number	:	623-691-4615
Fax Number	:	623-691-4620

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2008
Last Update Date	:	10/29/2008

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