MEDICARE: MACKENZIE ALISHIA CARR

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	163WC0200X	Critical Care Medicine Registered Nurse	RN2313762	MA
2	363LF0000X	Family Nurse Practitioner	RN2313762	MA

General Provider Information

NPI Number	:	1750252110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE ALISHIA CARR

Provider Business Mailing Address
First Line	:	PO BOX 24532
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-4532
Country	:	US
Telephone Number	:	978-658-9931
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 LOWELL ST
Second Line	:
City	:	WILMINGTON
State	:	MA
Zip	:	01887-2980
Country	:	US
Telephone Number	:	978-658-9931
Fax Number	:

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

Provider Enumeration Date	:	09/17/2025
Last Update Date	:	12/19/2025

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Directions to “ MACKENZIE ALISHIA CARR ” Practice Location

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