Provider Demographics
NPI:1205475456
Name:WOOLWICH, MACKENZIE (RDN)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:WOOLWICH
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 PRAIRIE VIEW DR APT 8235
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-7130
Mailing Address - Country:US
Mailing Address - Phone:262-331-4418
Mailing Address - Fax:
Practice Address - Street 1:225 PRAIRIE VIEW DR APT 8235
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-7130
Practice Address - Country:US
Practice Address - Phone:262-331-4418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-04
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered