MEDICARE: MISS MACKENZIE MARIE EVELYN ESSEX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372600000X	Adult Companion

General Provider Information

NPI Number	:	1275421844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MACKENZIE MARIE EVELYN ESSEX

Provider Business Mailing Address
First Line	:	2536 CARLETON AVE
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-1221
Country	:	US
Telephone Number	:	308-385-5775
Fax Number	:	308-385-5780

Provider Business Practice Location Address
First Line	:	4179 NEVADA AVE
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-1107
Country	:	US
Telephone Number	:	308-385-5775
Fax Number	:	308-385-5780

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2025
Last Update Date	:	06/24/2025

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