Individual
CHRISTINE WILLEY MACKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN, RN-BC
Contact information
Practice address
1061 HARMON AVE STE 1D03, FORT STEWART, GA 31314-5641
(912) 435-5101
Mailing address
1061 HARMON AVE STE 1D03, FORT STEWART, GA 31314-5641
(912) 435-5101
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN320388L
PA
163WG0100X
Gastroenterology Registered Nurse
710724
TX
163WP2201X
Ambulatory Care Registered Nurse
710724
TX
163WX0106X
Occupational Health Registered Nurse
Primary
RN242355
GA
261QA1903X
Ambulatory Surgical Clinic/Center
227203
NC
Other
Enumeration date
09/04/2014
Last updated
09/04/2014
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