Individual
MACKENZIE TULLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
2825 E BARNETT RD, MEDFORD, OR 97504-8332
(541) 789-7000
Mailing address
PO BOX 4749, MEDFORD, OR 97501-0227
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
10012139
OR
Other
Enumeration date
07/20/2023
Last updated
07/20/2023
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