Provider Demographics
NPI:1770769200
Name:MCKINNEY-GARCIA, MAXINE
Entity type:Individual
Prefix:MS
First Name:MAXINE
Middle Name:
Last Name:MCKINNEY-GARCIA
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 1:939 E 167TH PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-3102
Mailing Address - Country:US
Mailing Address - Phone:847-704-0997
Mailing Address - Fax:
Practice Address - Street 1:939 E 167TH PL
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-3102
Practice Address - Country:US
Practice Address - Phone:847-704-0997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide