Provider Demographics
NPI:1205628237
Name:ROSENBERGER, MAKENZY ALEXIS
Entity type:Individual
Prefix:
First Name:MAKENZY
Middle Name:ALEXIS
Last Name:ROSENBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 CLEVELAND AVE SE
Mailing Address - Street 2:
Mailing Address - City:BONDURANT
Mailing Address - State:IA
Mailing Address - Zip Code:50035-2014
Mailing Address - Country:US
Mailing Address - Phone:641-990-5606
Mailing Address - Fax:
Practice Address - Street 1:2301 W 1ST ST
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-2470
Practice Address - Country:US
Practice Address - Phone:515-304-4263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-17
Last Update Date:2025-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA182040363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily