NPI 1194555128 · live from the CMS NPI Registry
Mackenzie Rae Beacom, APRN, CPNP
Nurse Practitioner, Pediatrics in Saint Paul, MN. National Provider Identifier 1194555128, active.
NPI record
| NPI | 1194555128 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Pediatrics 363LP0200X |
| Practice location | 345 Smith Ave N, Saint Paul, MN 55102 |
| Practice phone | 651-220-6000 |
| Mailing address | 5875 Teakwood Ln N Apt B, Plymouth, MN 55442 |
| Enumerated | August 5, 2024 |
| Last updated | August 5, 2024 |
| Sole proprietor | No |
| Other names | Mackenzie Vanbuskirk |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner, Pediatrics primary | 363LP0200X | 11806 (MN) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.