Provider Demographics
NPI:1740091719
Name:HAIDET, MACKENZIE
Entity type:Individual
Prefix:MR
First Name:MACKENZIE
Middle Name:
Last Name:HAIDET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5085 OAK KNOLL AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44444-9493
Mailing Address - Country:US
Mailing Address - Phone:234-830-3298
Mailing Address - Fax:
Practice Address - Street 1:5085 OAK KNOLL AVE
Practice Address - Street 2:
Practice Address - City:NEWTON FALLS
Practice Address - State:OH
Practice Address - Zip Code:44444-9493
Practice Address - Country:US
Practice Address - Phone:234-830-3298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide