Provider Demographics
NPI:1629580022
Name:RESHEW, MACKENZIE JULIENNE (CPNP-PC, RN)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:JULIENNE
Last Name:RESHEW
Suffix:
Gender:F
Credentials:CPNP-PC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 S 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-2472
Mailing Address - Country:US
Mailing Address - Phone:303-659-4248
Mailing Address - Fax:
Practice Address - Street 1:183 S 18TH AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2472
Practice Address - Country:US
Practice Address - Phone:303-659-4248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1651392163W00000X
COAPN.0993502-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse