Healthcare Provider Details

I. General information

NPI: 1437095601
Provider Name (Legal Business Name): MACKENZIE V WERNICKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 SHUCKIN ST UNIT 105
HAMPSTEAD NC
28443-8731
US

IV. Provider business mailing address

1919 BRAXTON CT APT 103
WILMINGTON NC
28412-1204
US

V. Phone/Fax

Practice location:
  • Phone: 910-599-2230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1530469
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: