Doctor Name: | KATHLEEN A MACMAHON |
NPI Number: | 1518197995 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 558798 |
Business Practice Address: | 150 Tejas Pl Nipomo, CA - 934449123 |
Business Phone Number: | 8059293211 |
Business Fax Number: | 8059296359 |
Mailing Address: | 150 Tejas Pl, NIPOMO |
State: | CA |
Postal Code: | 934449123 |
Phone Number: | 8059293211 |
Fax Number: | 8059296359 |
NPI Enumeration Date: | 07/21/2009 |
NPI Last Update Date: | 05/09/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 558798 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |