Individual
MONICA A MACKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NPC
Contact information
Practice address
4201 CAMPUS RIDGE DRIVE, MIDLAND, MI 48640
(989) 488-5450
(989) 488-5455
Mailing address
4201 CAMPUS RIDGE DRIVE, MIDLAND, MI 48640
(989) 488-5450
(989) 488-5455
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704215621
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0Z90077
BCBS
MI
01
—
0Z90078
BCBS
MI
01
—
1029791
MCLAREN HEALTH PLAN
MI
Enumeration date
08/31/2006
Last updated
11/02/2016
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