Individual
MACKENZIE E DOUGLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, CNM
Contact information
Practice address
1505 SOQUEL DR STE 1, SANTA CRUZ, CA 95065-1716
(831) 465-5440
(831) 462-2017
Mailing address
3400 DATA DR, ATTN CREDENTIALING/PAYER ENROLLMENT, RANCHO CORDOVA, CA 95670-7956
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
209.010345
IL
367A00000X
Advanced Practice Midwife
Primary
95212458
CA
367A00000X
Advanced Practice Midwife
APRN.CNM.019342
OH
Other
Enumeration date
06/12/2013
Last updated
07/31/2020
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