Healthcare Provider Details

I. General information

NPI: 1144889544
Provider Name (Legal Business Name): MCKENZIE BREKKEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 6TH AVE S
CLEAR LAKE IA
50428-2606
US

IV. Provider business mailing address

621 S ILLINOIS AVE STE 103
MASON CITY IA
50401-5489
US

V. Phone/Fax

Practice location:
  • Phone: 641-357-2191
  • Fax: 641-357-6020
Mailing address:
  • Phone: 641-428-7766
  • Fax: 641-428-7788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR-11628
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: