Provider Demographics
NPI:1326417965
Name:MACKIE, KATTIE KOTOWSKI (RN, NC-BC, CPT)
Entity Type:Individual
Prefix:
First Name:KATTIE
Middle Name:KOTOWSKI
Last Name:MACKIE
Suffix:
Gender:F
Credentials:RN, NC-BC, CPT
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:MACKIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, NC-BC, CPT
Mailing Address - Street 1:148 COOPERS DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-2120
Mailing Address - Country:US
Mailing Address - Phone:302-367-5168
Mailing Address - Fax:
Practice Address - Street 1:16 POLLY DRUMMOND SHPG CTR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-4861
Practice Address - Country:US
Practice Address - Phone:302-367-5168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0046698163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse