Provider Demographics
NPI:1528190428
Name:MCKIE, COLETTE
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:
Last Name:MCKIE
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 1:3231 SUPERIOR LN
Mailing Address - Street 2:SUITE A6
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1923
Mailing Address - Country:US
Mailing Address - Phone:301-352-2520
Mailing Address - Fax:301-352-0836
Practice Address - Street 1:3231 SUPERIOR LN
Practice Address - Street 2:SUITE A6
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1923
Practice Address - Country:US
Practice Address - Phone:301-352-2520
Practice Address - Fax:301-352-0836
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00944171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist