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General NPI Number Information
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NPI Number | 1962311696
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Entity Type | Individual
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Provider Name | JOSHUA MACKENZIE
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Gender | Male
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Dates
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Enumeration Date | 09/08/2026
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Last Update Date | 09/08/2026
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Provider Practice Location Address
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Address Line | 98 POPLAR ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-1758
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Country | US
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Telephone | 208-785-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 382 PARTRIDGE LN
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City | REXBURG
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State | ID
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Zip | 83440-3593
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Country | US
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Telephone | 208-243-2103
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 6981608
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License Number State | ID
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