Provider Demographics
NPI:1023821758
Name:BAKER, MACKENZIE JANE
Entity type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:JANE
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3326 S 133RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3604
Mailing Address - Country:US
Mailing Address - Phone:402-515-3356
Mailing Address - Fax:
Practice Address - Street 1:3326 S 133RD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3604
Practice Address - Country:US
Practice Address - Phone:402-515-3356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No385H00000XRespite Care FacilityRespite Care