Healthcare Provider Details

I. General information

NPI: 1760210314
Provider Name (Legal Business Name): MACKENZIE MULLIGAN HOFFMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 BELMONT AVE
YOUNGSTOWN OH
44504-1006
US

IV. Provider business mailing address

1044 BELMONT AVE PO BOX 1790
YOUNGSTWON OH
44501
US

V. Phone/Fax

Practice location:
  • Phone: 330-746-7211
  • Fax:
Mailing address:
  • Phone: 330-480-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN.441303
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: