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General NPI Number Information
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NPI Number | 1245146596
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Entity Type | Individual
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Provider Name | MACKENZIE IVERSON
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Gender | Female
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Dates
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Enumeration Date | 08/19/2026
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Last Update Date | 08/19/2026
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Provider Practice Location Address
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Address Line | 800 LASALLE AVE STE 2800
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City | MINNEAPOLIS
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State | MN
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Zip | 55402-2039
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Country | US
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Telephone | 612-349-8560
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Fax |
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Provider Business Mailing Address
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Address Line | 19734 YORK ST NW
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City | ELK RIVER
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State | MN
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Zip | 55330-8231
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Country | US
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Telephone |
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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 | 209800000X
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Taxonomy Name | Legal Medicine (M.D./D.O.) Physician
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License Number | 2458837
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License Number State | MN
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