Provider Demographics
NPI:1780801423
Name:MCKINNON, MARSHA LEE (RN)
Entity type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:LEE
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 STARIN ROAD
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190
Mailing Address - Country:US
Mailing Address - Phone:262-472-1300
Mailing Address - Fax:262-472-5608
Practice Address - Street 1:710 STARIN ROAD
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190
Practice Address - Country:US
Practice Address - Phone:262-472-1300
Practice Address - Fax:262-472-5608
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI57086-030163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health