Provider Demographics
NPI:1033429881
Name:MACKENZIE, JAMIE ELIZABETH (RN)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:ELIZABETH
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USAG-J
Mailing Address - Street 2:UNIT 45013 BOX 2578
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96338-5013
Mailing Address - Country:US
Mailing Address - Phone:312-263-5050
Mailing Address - Fax:312-263-4100
Practice Address - Street 1:USAG-J MEDDAC PM
Practice Address - Street 2:UNIT 45013 BOX 2578
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96338-5013
Practice Address - Country:US
Practice Address - Phone:312-263-5050
Practice Address - Fax:312-263-4100
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN 00074430163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9261OtherCERTIFIED SPECIALIST AND CASE MANAGER IN OCCUAPTIONL HEALTH
WARN 00074430OtherREGISTERED NURSE LICENSE