Provider Demographics
NPI:1821277310
Name:MACKAY, ROSALIE C (COTA)
Entity Type:Individual
Prefix:MRS
First Name:ROSALIE
Middle Name:C
Last Name:MACKAY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W MICHIGAN ST
Mailing Address - Street 2:PROSTEP/EXTENDICARE HEALTH SERVICES
Mailing Address - City:MILWAUKEE,
Mailing Address - State:WI
Mailing Address - Zip Code:53203
Mailing Address - Country:US
Mailing Address - Phone:570-724-5270
Mailing Address - Fax:570-724-5276
Practice Address - Street 1:111 W MICHIGAN ST
Practice Address - Street 2:PROSTEP/EXTENDICARE HEALTH SERVICES
Practice Address - City:MILWAUKEE,
Practice Address - State:WI
Practice Address - Zip Code:53203
Practice Address - Country:US
Practice Address - Phone:570-724-5270
Practice Address - Fax:570-724-5276
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006475172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker