Healthcare Provider Details

I. General information

NPI: 1750252110
Provider Name (Legal Business Name): MACKENZIE ALISHIA CARR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 LOWELL ST
WILMINGTON MA
01887-2980
US

IV. Provider business mailing address

3 LIBRA LN
TOWNSEND MA
01469-1370
US

V. Phone/Fax

Practice location:
  • Phone: 978-658-9931
  • Fax:
Mailing address:
  • Phone: 978-604-2010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN2313762
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: