Individual
DACIA WILSON MACKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3920 DUTCHMANS LN, LOUISVILLE, KY 40207-4702
(502) 259-6710
(502) 259-6704
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3015650
KY
367500000X
Certified Registered Nurse Anesthetist
4087
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300047669
—
IN
05
—
7100717610
—
KY
05
—
AN2027
—
SC
Enumeration date
10/20/2009
Last updated
07/27/2023
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