Individual
MACKENZIE HEATHER PUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5 LANE LN, SHERIDAN, WY 82801-8630
(307) 674-6878
Mailing address
5 LANE LN, SHERIDAN, WY 82801-8630
(307) 674-6878
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/29/2012
Last updated
11/29/2012
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