Provider Demographics
NPI:1881372944
Name:MACKENZIE, CORINNE GRACE (PA-C)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:GRACE
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:136 SUNSET VIEW DR
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1274
Mailing Address - Country:US
Mailing Address - Phone:610-203-2030
Mailing Address - Fax:
Practice Address - Street 1:4755 OGLETOWN STANTON RD STE 2E99
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-2200
Practice Address - Country:US
Practice Address - Phone:302-733-5982
Practice Address - Fax:302-733-6081
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-10-23
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Provider Licenses
StateLicense IDTaxonomies
DEC5-0011941363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant