Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106S00000X | Behavior Technician | ||
Y | 156F00000X | Technician/Technologist |
NPI | 1134615420 |
---|---|
Provider Name | Mackenzie Rae Narkun |
First Address | Flat Rock, MI 48134-9585 |
Second Address | Dearborn, MI 48124-2044 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2018 |
Last Update Date | 21/06/2021 |