Individual
MS. GLENNA MACKINNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1642 NORTH COAST HWY, NEWPORT, OK 97405-2357
(541) 574-9174
Mailing address
1642 N COAST HWY, NEWPORT, OR 97365-2357
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5231
OR
Other
Enumeration date
07/16/2008
Last updated
07/16/2008
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