Mackenzie E Douglass, MSN, CNM
Advanced Practice Midwife in Santa Cruz, CA. Individual provider (NPI-1).
NPI number1922446889
StatusActive
Last updated in NPPESJul 31, 2020
Details
- NPI
- 1922446889
- Entity type
- Individual (NPI-1)
- Name
- Mackenzie E Douglass
- Credential
- MSN, CNM
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 12, 2013
- Certification date
- Jul 31, 2020
- Last updated
- Jul 31, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 367A00000X | Advanced Practice Midwife | 95212458 | CA | Yes |
| 367A00000X | Advanced Practice Midwife | APRN.CNM.019342 | OH | |
| 367A00000X | Advanced Practice Midwife | 209.010345 | IL |
Practice location
1505 Soquel Dr Ste 1Santa Cruz, CA 95065-1716
Phone 831-465-5440 · Fax 831-462-2017
Mailing address
3400 Data DrAttn Credentialing/Payer Enrollment
Rancho Cordova, CA 95670-7956
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