Provider Demographics
NPI:1538744511
Name:BRODSKY, MACKENZIE (RN)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:BRODSKY
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 1:224 16TH ST S APT 2
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4372
Mailing Address - Country:US
Mailing Address - Phone:698-498-7654
Mailing Address - Fax:
Practice Address - Street 1:224 16TH ST S APT 2
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4372
Practice Address - Country:US
Practice Address - Phone:608-498-7654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI248202163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health