Healthcare Provider Details

I. General information

NPI: 1285446203
Provider Name (Legal Business Name): MACKENZIE HARRISON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WESTWOOD DR
HAMILTON MT
59840-2345
US

IV. Provider business mailing address

315 S 3RD ST APT B
HAMILTON MT
59840-2709
US

V. Phone/Fax

Practice location:
  • Phone: 406-375-4746
  • Fax:
Mailing address:
  • Phone: 928-310-6435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberNUR-RN-LIC-234436
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: