Individual
MACKENNA HAVENOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2216 LESTER DR NE, ALBUQUERQUE, NM 87112-2607
(505) 296-4808
Mailing address
3037 MACKLAND AVE NE, ALBUQUERQUE, NM 87106-2054
(505) 818-9757
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
53325
NM
Other
Enumeration date
06/05/2023
Last updated
06/05/2023
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