Healthcare Provider Details

I. General information

NPI: 1922962638
Provider Name (Legal Business Name): MAKENZIE SCRUGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TOBI SCRUGGS

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 TRAILRIDGE RD
NORFOLK NE
68701-6956
US

IV. Provider business mailing address

312 TRAILRIDGE RD
NORFOLK NE
68701-6956
US

V. Phone/Fax

Practice location:
  • Phone: 402-981-8634
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: