Healthcare Provider Details

I. General information

NPI: 1467200063
Provider Name (Legal Business Name): ROSEMARY ANNE MACKENZIE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROSEMARY ANNE FELDPAUSCH

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 BARFIELD DR SE
GRAND RAPIDS MI
49546-5503
US

IV. Provider business mailing address

2505 BARFIELD DR SE
GRAND RAPIDS MI
49546-5503
US

V. Phone/Fax

Practice location:
  • Phone: 989-640-5134
  • Fax:
Mailing address:
  • Phone: 989-640-5134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: