Healthcare Provider Details

I. General information

NPI: 1548372386
Provider Name (Legal Business Name): MONICA A MACKENZIE NPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1484 STRAITS DR STE 5
BAY CITY MI
48706-8718
US

IV. Provider business mailing address

PO BOX 40412
BELFAST ME
04915-1255
US

V. Phone/Fax

Practice location:
  • Phone: 989-667-8740
  • Fax:
Mailing address:
  • Phone: 989-667-8740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704215621
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: