Provider Demographics
NPI:1003700436
Name:LUDWIG, MACKENZIE RENEE
Entity type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:RENEE
Last Name:LUDWIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19381 OIL CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CUSTAR
Mailing Address - State:OH
Mailing Address - Zip Code:43511-9751
Mailing Address - Country:US
Mailing Address - Phone:937-844-7874
Mailing Address - Fax:
Practice Address - Street 1:19381 OIL CENTER RD
Practice Address - Street 2:
Practice Address - City:CUSTAR
Practice Address - State:OH
Practice Address - Zip Code:43511-9751
Practice Address - Country:US
Practice Address - Phone:937-844-7874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide