Provider Demographics
NPI:1437504099
Name:THIMM, MAKENZIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MAKENZIE
Middle Name:
Last Name:THIMM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39781 CANNON DR
Mailing Address - Street 2:
Mailing Address - City:HARRISON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-1550
Mailing Address - Country:US
Mailing Address - Phone:586-634-6825
Mailing Address - Fax:
Practice Address - Street 1:39781 CANNON DR
Practice Address - Street 2:
Practice Address - City:HARRISON TWP
Practice Address - State:MI
Practice Address - Zip Code:48045-1550
Practice Address - Country:US
Practice Address - Phone:586-634-6825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704259181163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine