Provider Demographics
NPI:1356010722
Name:REDENIUS, MAKENZIE LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:LEE
Last Name:REDENIUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MAKENZIE
Other - Middle Name:LEE
Other - Last Name:HAENSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:201 W 69TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2403
Mailing Address - Country:US
Mailing Address - Phone:605-336-0635
Mailing Address - Fax:605-444-5498
Practice Address - Street 1:201 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2403
Practice Address - Country:US
Practice Address - Phone:605-336-0635
Practice Address - Fax:605-444-5498
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant