Provider Demographics
NPI:1891950697
Name:MACKINNON, ELIZABETH MERRILL (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MERRILL
Last Name:MACKINNON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2293 SUGAR HILL RD STE D
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-7787
Mailing Address - Country:US
Mailing Address - Phone:828-652-8727
Mailing Address - Fax:828-652-8793
Practice Address - Street 1:2293 SUGAR HILL RD STE D
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752
Practice Address - Country:US
Practice Address - Phone:828-652-8727
Practice Address - Fax:828-652-8793
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004065363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1891950697Medicaid