Individual provider · NPI-1

Mackenzie Rae Beacom, APRN, CPNP

Nurse Practitioner, Pediatrics · Saint Paul, MN

NPI number1194555128
StatusActive
Last updated in NPPESAug 5, 2024

Details

NPI
1194555128
Entity type
Individual (NPI-1)
Name
Mackenzie Rae Beacom
Credential
APRN, CPNP
Sex
Female
Sole proprietor
No
Enumeration date
Aug 5, 2024
Certification date
Aug 5, 2024
Last updated
Aug 5, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LP0200X Nurse Practitioner, Pediatrics11806MNYes

Other names

  • Mackenzie Vanbuskirk (Former Name)

Practice location

345 Smith Ave N
Saint Paul, MN 55102-2346

Phone 651-220-6000

Mailing address

5875 Teakwood Ln N Apt B
Plymouth, MN 55442-1590

Phone 651-336-7586

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