Healthcare Provider Details

I. General information

NPI: 1396638169
Provider Name (Legal Business Name): ALEXA MACKENZIE MACCANI DNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2025
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 COOPER AVE
SAGINAW MI
48602-5383
US

IV. Provider business mailing address

5 OXFORD KNOLL CT
FRANKENMUTH MI
48734-9305
US

V. Phone/Fax

Practice location:
  • Phone: 989-583-0000
  • Fax:
Mailing address:
  • Phone: 719-242-7824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704371805
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: