Individual
MACKENZIE PRENTICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
S73W17268 LAKE DR, MUSKEGO, WI 53150-9353
(507) 398-6144
Mailing address
S73W17268 LAKE DR, MUSKEGO, WI 53150-9353
(507) 398-6144
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
11460
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11460
WISCONSIN APNP LICENSE NUMBER
WI
Enumeration date
10/18/2021
Last updated
11/15/2021
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