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NPI Code Detail

MEDICARE: MACKENZIE BUZZARD FNP

MEDICARE: MACKENZIE BUZZARD FNP
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
1363LF0000XFamily Nurse Practitioner209.027613IL

General Provider Information

NPI Number : 1689359267
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACKENZIE BUZZARD FNP
Provider Business Mailing Address
First Line : PO BOX 372
Second Line :
City : MATTOON
State : IL
Zip : 61938-0372
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2040 LINCOLN AVE STE 100
Second Line :
City : CHARLESTON
State : IL
Zip : 61920-3197
Country : US
Telephone Number : 217-345-2030
Fax Number : 217-345-2045
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2023
Last Update Date : 11/04/2024

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Directions to “ MACKENZIE BUZZARD FNP” Practice Location

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