Provider Demographics
NPI:1447859699
Name:PAUER, MACKENZIE RYAN (LPN)
Entity type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:RYAN
Last Name:PAUER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:MACKENZIE
Other - Middle Name:RYAN
Other - Last Name:SARBACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1362 VINE ST
Mailing Address - Street 2:
Mailing Address - City:UNION GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53182-1507
Mailing Address - Country:US
Mailing Address - Phone:262-221-0924
Mailing Address - Fax:
Practice Address - Street 1:5735 DURAND AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-5011
Practice Address - Country:US
Practice Address - Phone:262-977-9488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI325707164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1447859699Medicaid