Healthcare Provider Details

I. General information

NPI: 1346765146
Provider Name (Legal Business Name): MACKENZIE SHIREMAN DNP, RN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E CENTER ST STE A
WARSAW IN
46580-2840
US

IV. Provider business mailing address

112 E CENTER ST STE A
WARSAW IN
46580-2840
US

V. Phone/Fax

Practice location:
  • Phone: 574-213-2170
  • Fax: 866-793-8007
Mailing address:
  • Phone: 574-213-2170
  • Fax: 866-793-8007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71007581A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: