Provider Demographics
NPI:1790263143
Name:MACKENZIE, MICHELLE KENNEDY HEDEEN (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KENNEDY HEDEEN
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:KATHRYN
Other - Last Name:HEDEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11918 55TH AVE CT NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332
Mailing Address - Country:US
Mailing Address - Phone:425-503-7795
Mailing Address - Fax:
Practice Address - Street 1:4207 KITSAP WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-2447
Practice Address - Country:US
Practice Address - Phone:360-415-1080
Practice Address - Fax:360-415-1099
Is Sole Proprietor?:No
Enumeration Date:2018-07-29
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program