Provider Demographics
NPI:1518244912
Name:MCKINLEY, MARA LANE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARA
Middle Name:LANE
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2442 WHITE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:MI
Mailing Address - Zip Code:49635-9460
Mailing Address - Country:US
Mailing Address - Phone:231-352-5055
Mailing Address - Fax:
Practice Address - Street 1:1465 E. PARKDALE AVE3.
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MICHIGAN
Practice Address - Zip Code:49660
Practice Address - Country:UM
Practice Address - Phone:231-398-1590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704167176363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily