Healthcare Provider Details

I. General information

NPI: 1376217125
Provider Name (Legal Business Name): MCKENZIE M CONNELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MCKENZIE M SPRANGERS PA-C

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 SHAWANO AVE
GREEN BAY WI
54303-3216
US

IV. Provider business mailing address

PO BOX 19070
GREEN BAY WI
54307-9070
US

V. Phone/Fax

Practice location:
  • Phone: 920-496-4700
  • Fax:
Mailing address:
  • Phone: 920-496-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5703-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: