Healthcare Provider Details

I. General information

NPI: 1194554352
Provider Name (Legal Business Name): MACKENZIE O'HARA ANDERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 CITADEL DR E STE 505
COLORADO SPRINGS CO
80909-5372
US

IV. Provider business mailing address

685 CITADEL DR E STE 505
COLORADO SPRINGS CO
80909-5372
US

V. Phone/Fax

Practice location:
  • Phone: 719-265-4412
  • Fax:
Mailing address:
  • Phone: 719-265-4412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN.1698237
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPN.0999982-NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0999982-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: