Individual
MACKENZIE MATTERN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
390 N MAIN ST, BOUNTIFUL, UT 84010-6046
(801) 397-6400
Mailing address
390 N MAIN ST, BOUNTIFUL, UT 84010-6046
(801) 397-6300
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13451187-1205
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/10/2019
Last updated
02/23/2024
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