Provider Demographics
NPI:1164914404
Name:WECKER, MACKENZIE ROSE
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:ROSE
Last Name:WECKER
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 1:801 E DONEGAL ST
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-1135
Mailing Address - Country:US
Mailing Address - Phone:402-340-8951
Mailing Address - Fax:
Practice Address - Street 1:900 N CLARKSON ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-4254
Practice Address - Country:US
Practice Address - Phone:402-721-5480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer