Provider Demographics
NPI:1578977450
Name:HALLER, MACKENZIE LEIGH (DNP, APRN, CNP)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:LEIGH
Last Name:HALLER
Suffix:
Gender:F
Credentials:DNP, APRN, CNP
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:LEIGH
Other - Last Name:BODNAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:5067 55TH ST NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3809
Practice Address - Country:US
Practice Address - Phone:507-292-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7434363LF0000X
UT9042232-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse