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General NPI Number Information
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NPI Number | 1073389557
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Entity Type | Individual
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Provider Name | MAKENNA ALEXANDRA HARTZELL OD
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Gender | Female
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 1386 LEAD HILL BLVD STE 130
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City | ROSEVILLE
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State | CA
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Zip | 95661-2936
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Country | US
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Telephone | 916-318-7821
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Fax | 916-723-4449
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Provider Business Mailing Address
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Address Line | 3501 J ST APT 3
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City | SACRAMENTO
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State | CA
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Zip | 95816-5465
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Country | US
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Telephone | 916-539-2140
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT35598
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License Number State | CA
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