Healthcare Provider Details

I. General information

NPI: 1982592978
Provider Name (Legal Business Name): MACKENZIE LEE MORIN MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MACKENZIE LEE TREADWELL

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

IV. Provider business mailing address

11 OLD WESTERN AVE
WINTHROP ME
04364-4059
US

V. Phone/Fax

Practice location:
  • Phone: 207-623-1000
  • Fax:
Mailing address:
  • Phone: 207-740-2348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP261809
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN82362
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: