Provider Demographics
NPI:1912217761
Name:MACKI, JULIE KAYE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:KAYE
Last Name:MACKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 N 3300 E
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-5629
Mailing Address - Country:US
Mailing Address - Phone:208-521-5578
Mailing Address - Fax:
Practice Address - Street 1:51 N 3300 E
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-5629
Practice Address - Country:US
Practice Address - Phone:208-521-5578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver