Provider Demographics
NPI:1376268813
Name:MACKLIN, JAZZNIA
Entity Type:Individual
Prefix:
First Name:JAZZNIA
Middle Name:
Last Name:MACKLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7321 MISTY GLOW CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-8200
Mailing Address - Country:US
Mailing Address - Phone:702-563-7808
Mailing Address - Fax:
Practice Address - Street 1:7321 MISTY GLOW CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-8200
Practice Address - Country:US
Practice Address - Phone:702-563-7808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant