Healthcare Provider Details

I. General information

NPI: 1447095518
Provider Name (Legal Business Name): MACKENZIE ROSE LOWNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1752 E LUGONIA AVE # 117-4949
REDLANDS CA
92374-2730
US

IV. Provider business mailing address

235 WELLESLEY ST
WESTON MA
02493-1572
US

V. Phone/Fax

Practice location:
  • Phone: 512-655-3578
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95351066
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95039549
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2380539
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: