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NPI Code Detail

MEDICARE: MACKENZIE K SULLIVAN RN

MEDICARE: MACKENZIE K SULLIVAN RN
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
1163WP0808XPsychiatric/Mental Health Registered Nurse1087534WI

General Provider Information

NPI Number : 1457211393
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACKENZIE K SULLIVAN RN
Provider Business Mailing Address
First Line : 200 S HICKORY ST
Second Line :
City : MAUSTON
State : WI
Zip : 53948-1320
Country : US
Telephone Number : 608-847-9270
Fax Number :
Provider Business Practice Location Address
First Line : 200 S HICKORY ST
Second Line :
City : MAUSTON
State : WI
Zip : 53948-1320
Country : US
Telephone Number : 608-847-9270
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2025
Last Update Date : 11/13/2025

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Directions to “ MACKENZIE K SULLIVAN RN” Practice Location

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