Provider Demographics
NPI:1023741402
Name:GAW, MACKENZIE ELISE (FNP)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:ELISE
Last Name:GAW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 LES DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:IN
Mailing Address - Zip Code:47610-9724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 W LONGEST ST
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:IN
Practice Address - Zip Code:47454-8821
Practice Address - Country:US
Practice Address - Phone:812-723-3994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012914A363L00000X
IN28247763A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner