Provider Demographics
NPI:1760026330
Name:STUTZMAN, MCKENZIE GRACE (CPM)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:GRACE
Last Name:STUTZMAN
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:GRACE
Other - Last Name:MCQUEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:450 LOST CREEK DR
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-890-8392
Mailing Address - Fax:
Practice Address - Street 1:611 3RD AVE W
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-890-8392
Practice Address - Fax:406-752-6892
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI234-049176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife