Provider Demographics
NPI:1760549737
Name:MACKEY, DONNA MARIE (LPN RN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:MACKEY
Suffix:
Gender:F
Credentials:LPN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 FIRST AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401
Mailing Address - Country:US
Mailing Address - Phone:845-331-9479
Mailing Address - Fax:
Practice Address - Street 1:57 HARMATI LANE
Practice Address - Street 2:
Practice Address - City:SHADY
Practice Address - State:NY
Practice Address - Zip Code:12409
Practice Address - Country:US
Practice Address - Phone:845-657-7323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3404661163W00000X
NY1324981164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02677085Medicaid