Provider Demographics
NPI:1700367489
Name:ARNOLD, MACKENZIE LEIGH-ROUSSE (WHNP, CNP, APN)
Entity Type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:LEIGH-ROUSSE
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:WHNP, CNP, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 ROYCE AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-5176
Mailing Address - Country:US
Mailing Address - Phone:989-415-2708
Mailing Address - Fax:
Practice Address - Street 1:2854 S 11TH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2129
Practice Address - Country:US
Practice Address - Phone:269-345-6197
Practice Address - Fax:269-345-9734
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704319967363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health