Individual
MACKENZIE RAE BEACOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CPNP
Contact information
Practice address
345 SMITH AVE N, SAINT PAUL, MN 55102-2346
(651) 220-6000
Mailing address
5875 TEAKWOOD LN N APT B, PLYMOUTH, MN 55442-1590
(651) 336-7586
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
11806
MN
Other
Enumeration date
08/05/2024
Last updated
08/05/2024
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