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General NPI Number Information
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NPI Number | 1942715818
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Entity Type | Individual
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Provider Name | KATHLEEN MACKENZIE APRN
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Gender | Female
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Dates
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Enumeration Date | 12/13/2017
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Last Update Date | 12/06/2019
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Provider Practice Location Address
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Address Line | 1007 N MAIN ST
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City | DAYVILLE
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State | CT
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Zip | 06241-2170
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Country | US
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Telephone | 860-774-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 177 GARY SCHOOL RD
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City | PUTNAM
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State | CT
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Zip | 06260-1861
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 7398
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License Number State | CT
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