Provider Demographics
NPI:1669997086
Name:MORGAN, MACKENZIE (RN)
Entity type:Individual
Prefix:MS
First Name:MACKENZIE
Middle Name:
Last Name:MORGAN
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 1:281 SAWYER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-3412
Mailing Address - Country:US
Mailing Address - Phone:970-247-5702
Mailing Address - Fax:970-375-7487
Practice Address - Street 1:281 SAWYER DR STE 300
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-3412
Practice Address - Country:US
Practice Address - Phone:970-247-5702
Practice Address - Fax:970-375-7487
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1641288163W00000X
NM69216363L00000X
COAPN.0996594-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000197497Medicaid
NM36725854Medicaid