Individual
MACKENZIE BROEREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP, PMHNP-BC
Contact information
Practice address
5471 W WATERFORD LN, APPLETON, WI 54913-8510
(920) 731-7445
(920) 882-0437
Mailing address
5337 W GRANDE MARKET DR, APPLETON, WI 54913-8442
(920) 731-7445
(920) 404-2351
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
229878-30
WI
363L00000X
Nurse Practitioner
14115-33
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
14115-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100243971
—
WI
05
—
100279786
—
WI
Enumeration date
06/29/2023
Last updated
05/05/2025
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