Healthcare Provider Details

I. General information

NPI: 1922981893
Provider Name (Legal Business Name): MACKENZIE A TORLINE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MACKENZIE A GOODIN APRN

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 BROADWAY ST
MADISON IN
47250-3310
US

IV. Provider business mailing address

630 BROADWAY ST # 2
MADISON IN
47250-3310
US

V. Phone/Fax

Practice location:
  • Phone: 812-801-0611
  • Fax:
Mailing address:
  • Phone: 812-801-0995
  • Fax: 812-801-8621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number28205773A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71017177A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: