1013078377 NPI number — MS. JEAN MACKENZIE

Table of content: MS. JEAN MACKENZIE (NPI 1013078377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013078377 NPI number — MS. JEAN MACKENZIE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACKENZIE
Provider First Name:
JEAN
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013078377
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 WIDGEON LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST YARMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02673-3819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-398-6967
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 PARK ST.
Provider Second Line Business Practice Location Address:
CAPE COD HOSPITAL
Provider Business Practice Location Address City Name:
HYANNIS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-771-1800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  1020696 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1020696 . This is a "SOCIAL WORKER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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