Provider Demographics
NPI:1215676044
Name:DEBOER, MACKENZIE (MASTER'S OF ARTS)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:DEBOER
Suffix:
Gender:F
Credentials:MASTER'S OF ARTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 BUSINESS PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-8961
Mailing Address - Country:US
Mailing Address - Phone:800-215-1259
Mailing Address - Fax:
Practice Address - Street 1:2560 BUSINESS PKWY STE A
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-8961
Practice Address - Country:US
Practice Address - Phone:800-215-1259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty