Provider Demographics
NPI:1619749454
Name:MACKAY, MERILEE (LPN)
Entity Type:Individual
Prefix:
First Name:MERILEE
Middle Name:
Last Name:MACKAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33811 9TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6707
Mailing Address - Country:US
Mailing Address - Phone:253-350-0882
Mailing Address - Fax:
Practice Address - Street 1:4411 BROWNS POINT BLVD
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-2041
Practice Address - Country:US
Practice Address - Phone:253-925-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60278975164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse