Individual
DIANA LEE MACKENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
36060 EUCLID AVE, WILLOUGHBY, OH 44094-4656
(440) 953-9600
Mailing address
5699 CHARMAR DR, MENTOR, OH 44060-1902
(440) 749-9456
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN.CNP.021979
OH
Other
Enumeration date
04/09/2018
Last updated
04/09/2018
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