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General NPI Number Information
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NPI Number | 1699168443
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Entity Type | Individual
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Provider Name | MACKENZIE ACUS STARNS PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/17/2015
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 1138 INDEPENDENCE AVE
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City | MARION
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State | OH
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Zip | 43302-6318
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Country | US
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Telephone | 740-383-7953
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Fax | 740-375-8114
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Provider Business Mailing Address
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Address Line | PO BOX 7527
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City | DUBLIN
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State | OH
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Zip | 43017-0727
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Country | US
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Telephone | 740-383-7953
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Fax | 740-375-8114
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C05737
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License Number State | MD
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