Provider Demographics
NPI:1356319909
Name:MACKAY, JANA M (ARNP)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:M
Last Name:MACKAY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 PALISADO AVE
Mailing Address - Street 2:GENESIS PHYSICIAN SVCS.
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2071
Mailing Address - Country:US
Mailing Address - Phone:860-687-3629
Mailing Address - Fax:860-687-3622
Practice Address - Street 1:24 OLD ETNA ROAD
Practice Address - Street 2:LEBANON CENTER GENESIS
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03301-7504
Practice Address - Country:US
Practice Address - Phone:603-448-2234
Practice Address - Fax:603-448-2087
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH037924-23-03363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30340527Medicaid
NHNP2046Medicare ID - Type Unspecified
NH30340527Medicaid