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General NPI Number Information
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NPI Number | 1073261749
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Entity Type | Individual
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Provider Name | MACKENZIE EUBANK
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Gender | Female
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Dates
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Enumeration Date | 03/12/2022
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 13123 E 16TH AVE
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City | AURORA
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State | CO
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Zip | 80045-7106
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Country | US
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Telephone | 970-218-2012
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Fax |
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Provider Business Mailing Address
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Address Line | 2848 URBAN PL
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City | BERTHOUD
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State | CO
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Zip | 80513-7091
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Country | US
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Telephone | 970-218-2012
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT.0002212
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License Number State | CO
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