| NPI | 1770216566 |
|---|---|
| Former Name | MAKENZIE BAUCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT NUR-APRN-LIC-196196) |
| Enumeration Date | 2022-07-08 |
| Last Update Date | 2022-07-08 |