Individual
MACKENZIE CAROLYN WALTZ DALLAIRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1601 HADDON AVE # A, CAMDEN, NJ 08103-3109
(856) 757-3840
Mailing address
301 LIPPINCOTT DR STE 410, MARLTON, NJ 08053-4197
(856) 757-3840
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
25MP00728700
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
PA
Other
Enumeration date
11/10/2021
Last updated
10/04/2024
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