Provider Demographics
NPI:1376229344
Name:WARNER, MACKENZIE JONA (CNP)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:JONA
Last Name:WARNER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31430 SD HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069
Mailing Address - Country:US
Mailing Address - Phone:605-760-1394
Mailing Address - Fax:
Practice Address - Street 1:321 MILL STREET
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:IA
Practice Address - Zip Code:51001
Practice Address - Country:US
Practice Address - Phone:712-568-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA174768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily