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1669101234
MACKENZIE GUSTAFSON
TWIN FALLS, ID
NPI
1669101234
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: ID 59468)
Enumeration Date
2022-06-08
Last Update Date
2022-08-19
Business Address
MACKENZIE GUSTAFSON PMHNP
414 SHOUP AVE W STE B
TWIN FALLS, ID 83301-5042
Phone number: 208-814-9100
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Mailing Address
MACKENZIE GUSTAFSON PMHNP
190 E BANNOCK ST
BOISE, ID 83712-6241
Phone number:
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