Provider Demographics
NPI:1053006940
Name:MACKE, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:MACKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5239 RITCHEY LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45065-8789
Mailing Address - Country:US
Mailing Address - Phone:513-313-7115
Mailing Address - Fax:
Practice Address - Street 1:5239 RITCHEY LN
Practice Address - Street 2:
Practice Address - City:SOUTH LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45065-8789
Practice Address - Country:US
Practice Address - Phone:513-313-7115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide