Provider Demographics
NPI:1386020063
Name:MACKIE, RONNIE SUE (NP)
Entity Type:Individual
Prefix:MRS
First Name:RONNIE
Middle Name:SUE
Last Name:MACKIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RONNIE
Other - Middle Name:SUE
Other - Last Name:DEARDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:156 LANSDOWNE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171
Mailing Address - Country:US
Mailing Address - Phone:617-594-2300
Mailing Address - Fax:
Practice Address - Street 1:25 HIGH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186
Practice Address - Country:US
Practice Address - Phone:617-594-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN234540163WC0200X, 163WM0705X
MACNPRN234540363LC0200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine