Provider Demographics
NPI:1033980123
Name:SCHNIDER, MACKENZIE L
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:L
Last Name:SCHNIDER
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 1:505 S LIMITS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:WI
Mailing Address - Zip Code:54822-8600
Mailing Address - Country:US
Mailing Address - Phone:715-651-2153
Mailing Address - Fax:
Practice Address - Street 1:505 S LIMITS AVE
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:WI
Practice Address - Zip Code:54822-8600
Practice Address - Country:US
Practice Address - Phone:715-651-2153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI93-3836132253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care