Provider Demographics
NPI:1427542273
Name:MACKINTOSH, BETH
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:MACKINTOSH
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 1:215 ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:KEWAUNEE
Mailing Address - State:WI
Mailing Address - Zip Code:54216-1005
Mailing Address - Country:US
Mailing Address - Phone:920-559-9463
Mailing Address - Fax:
Practice Address - Street 1:215 ELLIS ST
Practice Address - Street 2:
Practice Address - City:KEWAUNEE
Practice Address - State:WI
Practice Address - Zip Code:54216-1005
Practice Address - Country:US
Practice Address - Phone:920-559-9463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health