Mackenzie Ryan Pauer, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

325707 Issued in WI

Practice address

5735 Durand Ave
Mount Pleasant, WI 53406-5011

Phone

(262) 977-9488

NPI assigned

Oct 20, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Miss Mackenzie Ryan Sarbacker Former name

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: mackenzie.sarbacker@ctcprograms.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654214400000",
    "number": "1447859699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1362 VINE ST",
            "city": "UNION GROVE",
            "state": "WI",
            "postal_code": "531821507",
            "telephone_number": "262-221-0924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5735 DURAND AVE",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534065011",
            "telephone_number": "262-977-9488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAUER",
        "first_name": "MACKENZIE",
        "middle_name": "RYAN",
        "name_prefix": "Mrs.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-20",
        "last_updated": "2022-06-03",
        "certification_date": "2022-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "WI",
            "license": "325707",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447859699",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Mackenzie.sarbacker@ctcprograms.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5735 Durand Ave",
            "city": "Mount Pleasant",
            "state": "WI",
            "country_code": "US",
            "postal_code": "534065011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mackenzie.pauer@ctcprograms.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5735 Durand Ave",
            "city": "Mount Pleasant",
            "state": "WI",
            "country_code": "US",
            "postal_code": "534065011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MACKENZIE",
            "last_name": "SARBACKER",
            "middle_name": "RYAN",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Pediatric, Prenatal and Family Chiropractic of Wisconsin LLC

• Licensed Practical Nurse in Mount Pleasant, WI
• Providers in Mount Pleasant, WI by specialty
• Licensed Practical Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.