Healthcare Provider Details

I. General information

NPI: 1952168312
Provider Name (Legal Business Name): MACKENZIE ODONNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

749 UNIVERSITY ROW STE 200
MADISON WI
53705-1465
US

IV. Provider business mailing address

749 UNIVERSITY ROW STE 200
MADISON WI
53705-1465
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number101840851
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: