| Doctor Name: | WILMA ANNE MACKENZIE |
| NPI Number: | 1003215526 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | AGACNP-BC |
| License Number: | 4704280979 |
| Business Practice Address: | 1500 E Medical Center Drive 2nd Floor Taubman Center Recp G Ann Arbor, MI - 481095338 |
| Business Phone Number: | 7349367010 |
| Business Fax Number: | |
| Mailing Address: | 3621 S State St, 700 Kms Place ANN ARBOR |
| State: | MI |
| Postal Code: | 48108 |
| Phone Number: | 7349362047 |
| Fax Number: | |
| NPI Enumeration Date: | 08/20/2014 |
| NPI Last Update Date: | 08/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | 4704280979 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |