Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4704280979 | MI |
N | 363LA2100X | Nurse Practitioner - Acute Care | 4704280979 | MI |
NPI | 1003215526 |
---|---|
Provider Name | Wilma Anne Mackenzie |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-5000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2014 |
Last Update Date | 25/11/2019 |