Provider Demographics
NPI:1245078690
Name:EASTMAN, MACKENZIE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3959 CRYSTAL TRIP CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-8338
Mailing Address - Country:US
Mailing Address - Phone:253-209-0726
Mailing Address - Fax:
Practice Address - Street 1:5320 S RAINBOW BLVD STE 154
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1807
Practice Address - Country:US
Practice Address - Phone:702-853-3853
Practice Address - Fax:702-853-3854
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV843268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily