Provider Demographics
NPI:1619718731
Name:CHANDLER, MACKENZIE MAE (RN, BSN)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:MAE
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 CHESTNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-5317
Mailing Address - Country:US
Mailing Address - Phone:585-808-4689
Mailing Address - Fax:
Practice Address - Street 1:585 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-5317
Practice Address - Country:US
Practice Address - Phone:585-808-4689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY893095163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health