Provider Demographics
NPI:1407533672
Name:BROEREN, MACKENZIE (APNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:BROEREN
Suffix:
Gender:F
Credentials:APNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 N BAY HIGHLANDS DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-7320
Mailing Address - Country:US
Mailing Address - Phone:920-857-4058
Mailing Address - Fax:
Practice Address - Street 1:8200 W SILVER SPRING DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-2552
Practice Address - Country:US
Practice Address - Phone:414-760-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14115363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health