Provider Demographics
NPI:1235857764
Name:NERENHAUSEN, MACKENZIE KATHRYN
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:KATHRYN
Last Name:NERENHAUSEN
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 1:2321 MILFORD CIR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3924
Mailing Address - Country:US
Mailing Address - Phone:941-356-7059
Mailing Address - Fax:
Practice Address - Street 1:2321 MILFORD CIR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3924
Practice Address - Country:US
Practice Address - Phone:941-356-7059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician