Provider Demographics
NPI:1679037204
Name:MILLER, MACKENZIE KATE (CNM)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:KATE
Last Name:MILLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 TAYLOR AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-1077
Mailing Address - Country:US
Mailing Address - Phone:603-531-9944
Mailing Address - Fax:
Practice Address - Street 1:46 OBERY ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2237
Practice Address - Country:US
Practice Address - Phone:508-830-6116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife