Healthcare Provider Details

I. General information

NPI: 1275459760
Provider Name (Legal Business Name): MACKENZIE AUTUMN CASHIN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4805 S MOORLAND RD
NEW BERLIN WI
53151-7401
US

IV. Provider business mailing address

2051 HIGHLAND AVE
WAUKESHA WI
53186-2527
US

V. Phone/Fax

Practice location:
  • Phone: 262-798-7200
  • Fax:
Mailing address:
  • Phone: 715-451-8455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2026054961
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: