Individual
MACKENZIE J WEIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
306 149TH ST, SOUTH HAVEN, MN 55382-9140
(320) 291-0229
Mailing address
306 149TH ST, SOUTH HAVEN, MN 55382-9140
(320) 291-0229
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15408
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/08/2025
Last updated
07/02/2025
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