Provider Demographics
NPI:1780932574
Name:MACKEY, MEGAN VIRGINIA
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:VIRGINIA
Last Name:MACKEY
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 1:3827 31ST ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-4219
Mailing Address - Country:US
Mailing Address - Phone:330-452-2345
Mailing Address - Fax:
Practice Address - Street 1:3827 31ST ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-4219
Practice Address - Country:US
Practice Address - Phone:330-452-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401165191110376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide