Provider Demographics
NPI:1376294389
Name:WEILAND, MACKENZIE RAE (MSN, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:RAE
Last Name:WEILAND
Suffix:
Gender:F
Credentials:MSN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17202 AURORA AVE N APT 223
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-5354
Mailing Address - Country:US
Mailing Address - Phone:502-715-2696
Mailing Address - Fax:
Practice Address - Street 1:1509 32ND ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4302
Practice Address - Country:US
Practice Address - Phone:800-769-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61239218163W00000X
GARN297783163W00000X
WAAP61258631363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse