Provider Demographics
NPI:1508581588
Name:KRIEBEL, MACKENZIE LEIGH (CRNP)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:LEIGH
Last Name:KRIEBEL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746071
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6071
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:
Practice Address - Street 1:3551 BELMONT AVE STE 19B
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1439
Practice Address - Country:US
Practice Address - Phone:330-222-4030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2023-08-24
Deactivation Date:2022-10-12
Deactivation Code:
Reactivation Date:2022-10-31
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily