Provider Demographics
NPI:1003509332
Name:HEERDT, MACKENZIE
Entity Type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:
Last Name:HEERDT
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 1:802 N ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4821
Mailing Address - Country:US
Mailing Address - Phone:720-940-0280
Mailing Address - Fax:
Practice Address - Street 1:802 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4821
Practice Address - Country:US
Practice Address - Phone:720-940-0280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician