Healthcare Provider Details

I. General information

NPI: 1700547726
Provider Name (Legal Business Name): MACKENZIE REDNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2022
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 LINCOLN BLVD
LINCOLN CA
95648-7422
US

IV. Provider business mailing address

77 LINCOLN BLVD STE 1
LINCOLN CA
95648-7422
US

V. Phone/Fax

Practice location:
  • Phone: 916-258-2751
  • Fax:
Mailing address:
  • Phone: 916-258-2751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: