Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 1-138001 | AL |
NPI | 1003351727 |
---|---|
Provider Name | Mackenzie Krebsbach |
First Address | Orange Beach, AL 36561-1355 |
Second Address | Fairhope, AL 36532-2043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2017 |
Last Update Date | 04/01/2017 |