Individual
MACKENZIE HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
37 RUSHMORE RD, FOX LAKE, IL 60020-1623
(224) 213-4503
Mailing address
37 RUSHMORE RD, FOX LAKE, IL 60020-1623
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
10/27/2016
Last updated
10/27/2016
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