Provider Demographics
NPI:1407507791
Name:BIGNESS, MACENZIE
Entity Type:Individual
Prefix:
First Name:MACENZIE
Middle Name:
Last Name:BIGNESS
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 1:4376 GEORGIAN CT APT A34
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-3992
Mailing Address - Country:US
Mailing Address - Phone:315-414-8322
Mailing Address - Fax:
Practice Address - Street 1:1744 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-1902
Practice Address - Country:US
Practice Address - Phone:315-468-3414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator