Provider Demographics
NPI:1003148461
Name:MACKEY, NAOMI RENEE (RN)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:RENEE
Last Name:MACKEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:RENEE'
Other - Last Name:RUEDIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-3109
Mailing Address - Country:US
Mailing Address - Phone:541-451-5932
Mailing Address - Fax:
Practice Address - Street 1:1600 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-3109
Practice Address - Country:US
Practice Address - Phone:541-451-5932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200843096RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse