Individual
MACKENZIE ROSE VANDER BLOOMEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, FNP-C
Contact information
Practice address
1860 SHAWANO AVE, GREEN BAY, WI 54303-2667
(920) 272-1010
Mailing address
1326 SAND ACRES DR, DE PERE, WI 54115-9487
(920) 264-4346
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
230930-30
WI
363L00000X
Nurse Practitioner
Primary
11824-33
WI
Other
Enumeration date
12/18/2021
Last updated
10/13/2022
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