Individual
MACKENZIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5100 AUTUMN MEADOW AVE, LAS VEGAS, NV 89130-7007
(574) 870-2457
Mailing address
5100 AUTUMN MEADOW AVE, LAS VEGAS, NV 89130-7007
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
815145
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
815145
REGISTERED NURSE LICENSE
NV
Enumeration date
06/18/2020
Last updated
06/18/2020
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