Provider Demographics
NPI:1346384328
Name:MACKINNON, KAREN ANNE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ANNE
Last Name:MACKINNON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ANNE
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:8110 MAPLE LAWN BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2693
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:301-340-9027
Practice Address - Street 1:844 WASHINGTON RD STE 302
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157
Practice Address - Country:US
Practice Address - Phone:410-848-6294
Practice Address - Fax:410-848-3009
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1015287367A00000X
MDR130497367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife