Individual
MACKENZIE PRANDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1802 BRAEBURN DR, SALEM, VA 24153-7357
(540) 772-3530
(540) 776-2036
Mailing address
2000 HEALTH PARK DR FL HP2, BRENTWOOD, TN 37027-4692
(615) 373-7600
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110002209
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010244161
—
VA
05
—
1659342327
—
VA
01
—
P00304575
MEDICARE RAILROAD
VA
Enumeration date
01/30/2006
Last updated
01/04/2022
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