Provider Demographics
NPI:1750580544
Name:MACKIE, SHAROL DIANE (FNP)
Entity type:Individual
Prefix:MRS
First Name:SHAROL
Middle Name:DIANE
Last Name:MACKIE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1355 EAST ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0801
Mailing Address - Country:US
Mailing Address - Phone:530-605-4260
Mailing Address - Fax:530-605-4265
Practice Address - Street 1:1355 EAST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0801
Practice Address - Country:US
Practice Address - Phone:530-605-4260
Practice Address - Fax:530-605-4265
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA12909363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner