Provider Demographics
NPI:1558016881
Name:SACHS, MACKENZIE (RDN)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:SACHS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:BROWNING
Mailing Address - State:MT
Mailing Address - Zip Code:59417-5093
Mailing Address - Country:US
Mailing Address - Phone:406-845-6461
Mailing Address - Fax:
Practice Address - Street 1:108 2ND ST NW
Practice Address - Street 2:
Practice Address - City:BROWNING
Practice Address - State:MT
Practice Address - Zip Code:59417-5093
Practice Address - Country:US
Practice Address - Phone:406-845-6461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT81154133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTMED-NUTR-LIC-81154OtherMONTANA STATE BOARD CERT. LICENSE