MEDICARE: MACKENZIE O'HARA ANDERSON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WM0102X	Maternal Newborn Registered Nurse	RN.1698237	CO
2	363LW0102X	Women's Health Nurse Practitioner	APN.0999982-NP	CO
3	363L00000X	Nurse Practitioner	APN.0999982-NP	CO

General Provider Information

NPI Number	:	1194554352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE O'HARA ANDERSON NP

Provider Business Mailing Address
First Line	:	685 CITADEL DR E STE 505
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-5372
Country	:	US
Telephone Number	:	719-265-4412
Fax Number	:

Provider Business Practice Location Address
First Line	:	685 CITADEL DR E STE 505
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-5372
Country	:	US
Telephone Number	:	719-265-4412
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2024
Last Update Date	:	11/13/2024

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