Healthcare Provider Details

I. General information

NPI: 1720946577
Provider Name (Legal Business Name): MACKENZIE KORTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 HOLTON RD STE 500
MUSKEGON MI
49445-1505
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR # J2000
ANN ARBOR MI
48105-9484
US

V. Phone/Fax

Practice location:
  • Phone: 231-370-1280
  • Fax: 231-672-7886
Mailing address:
  • Phone: 734-747-6766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704345952
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704345952
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: