Provider Demographics
NPI:1891082376
Name:MACKEL, GEORGE S (PMHNP)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:S
Last Name:MACKEL
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12034 BIG CANOE
Mailing Address - Street 2:
Mailing Address - City:BIG CANOE
Mailing Address - State:GA
Mailing Address - Zip Code:30143-5154
Mailing Address - Country:US
Mailing Address - Phone:808-777-9460
Mailing Address - Fax:808-217-9174
Practice Address - Street 1:524 KEAWE ST # 521
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3101
Practice Address - Country:US
Practice Address - Phone:808-777-9460
Practice Address - Fax:808-217-9174
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-2714363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily