Basic Information
| Provider Information | |||||||||
| NPI: | 1376294389 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEILAND | ||||||||
| FirstName: | MACKENZIE | ||||||||
| MiddleName: | RAE | ||||||||
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| Credential: | MSN, WHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17202 AURORA AVE N APT 223 | ||||||||
| Address2: | |||||||||
| City: | SHORELINE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981335354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5027152696 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1509 32ND ST | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982014302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007690045 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2022 | ||||||||
| LastUpdateDate: | 01/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN61239218 | WA | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN297783 | GA | N | Nursing Service Providers | Registered Nurse | 363LW0102X | AP61258631 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.