Provider Demographics
NPI:1598354946
Name:MACKEY, DIANE FRANCES (RN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:FRANCES
Last Name:MACKEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 FRANK BLVD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1022
Mailing Address - Country:US
Mailing Address - Phone:033-062-0388
Mailing Address - Fax:
Practice Address - Street 1:770 FRANK BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1022
Practice Address - Country:US
Practice Address - Phone:033-062-0388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH384255163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice