Individual
MCKENZIE BRACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2820 INGLEWOOD AVE S, MINNEAPOLIS, MN 55416-4112
(914) 589-5503
(763) 465-0588
Mailing address
3243 FILLMORE ST NE, MINNEAPOLIS, MN 55418-2152
(319) 939-8354
Taxonomy
Speciality
Code
Description
License number
State
163WC3500X
Cardiac Rehabilitation Registered Nurse
2375351
MN
363L00000X
Nurse Practitioner
Primary
8342
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2375351
RN
MN
Enumeration date
09/12/2019
Last updated
08/03/2021
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