Provider Demographics
NPI:1558128884
Name:MACKLIN, MIA ME'CHELLE
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:ME'CHELLE
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 1:4617 DALLAS PL APT T2
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-3341
Mailing Address - Country:US
Mailing Address - Phone:240-817-6336
Mailing Address - Fax:
Practice Address - Street 1:4617 DALLAS PL APT T2
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-3341
Practice Address - Country:US
Practice Address - Phone:240-817-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty