Provider Demographics
NPI:1790420131
Name:GARBANI, MACKENZIE LOYCE (APRN-CNS)
Entity Type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:LOYCE
Last Name:GARBANI
Suffix:
Gender:F
Credentials:APRN-CNS
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:LOYCE
Other - Last Name:BRISCOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7428 NW 115TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-2711
Mailing Address - Country:US
Mailing Address - Phone:405-535-7505
Mailing Address - Fax:
Practice Address - Street 1:1000 N LINCOLN BLVD # 4000
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-3252
Practice Address - Country:US
Practice Address - Phone:405-271-4912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-30
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0130175163W00000X
OK209153364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse