Provider Demographics
NPI:1619059532
Name:MACKEY, MARY VICTORIA (CNM)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:VICTORIA
Last Name:MACKEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:VICTORIA
Other - Last Name:STROBL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:227 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2228
Mailing Address - Country:US
Mailing Address - Phone:276-236-2909
Mailing Address - Fax:276-236-8845
Practice Address - Street 1:227 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2228
Practice Address - Country:US
Practice Address - Phone:276-236-2909
Practice Address - Fax:276-236-8845
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024068295367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7791267Medicaid
VA7791267Medicaid