Provider Demographics
NPI:1336891449
Name:CUCANCIC, MACKENZIE LEIGH (RN)
Entity Type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:LEIGH
Last Name:CUCANCIC
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 W WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:KIRBYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75956-1538
Mailing Address - Country:US
Mailing Address - Phone:936-715-7199
Mailing Address - Fax:
Practice Address - Street 1:494 SPRINGHILL ST STE 100
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-5055
Practice Address - Country:US
Practice Address - Phone:936-715-7199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX883819163W00000X
TX2021210317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse