Provider Demographics
NPI:1689951014
Name:MACKIE, LAUREN RAE (CNP)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:RAE
Last Name:MACKIE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:RAE
Other - Last Name:DENCZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:6133 SLAVIN CIR NW
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-8227
Mailing Address - Country:US
Mailing Address - Phone:330-704-4453
Mailing Address - Fax:
Practice Address - Street 1:2600 6TH ST SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1702
Practice Address - Country:US
Practice Address - Phone:330-363-6281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.12806-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily