Provider Demographics
NPI:1760929459
Name:WESNER, MAKENZIE (NP)
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:
Last Name:WESNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 SAMARITAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3912
Mailing Address - Country:US
Mailing Address - Phone:408-389-3538
Mailing Address - Fax:408-358-1802
Practice Address - Street 1:2450 SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3912
Practice Address - Country:US
Practice Address - Phone:408-389-3538
Practice Address - Fax:408-228-1988
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005475363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics