Individual provider Active NPI

Mackenzie Johnson Riordan, RN

  • Certified Registered Nurse Anesthetist
  • Detroit, MI
National Provider Identifier
1730064544
Registry record updated Sep 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704405119 Issued in MI
Practice address
2799 W Grand Blvd
Detroit, MI 48202-2608
Phone
(313) 916-2545
NPI assigned
Aug 11, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 4704405119 MI
Certified Registered Nurse Anesthetist 367500000X 4704405119 MI Primary

Addresses

Primary practice location

2799 W Grand Blvd
Detroit, MI 48202-2608

Mailing address

PO Box 670884
Detroit, MI 48267-0884
Phone (800) 436-7936

Other practice location 1

4001 W McNichols Rd
Detroit, MI 48221-3038
Phone (313) 993-1245

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
4704405119MIMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
University of Detroit Mercy PastSince Nov 7, 2025 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1754870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789084800000",
    "number": "1730064544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 670884",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482670884",
            "telephone_number": "800-436-7936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2799 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022608",
            "telephone_number": "313-916-2545"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4001 W McNichols Rd",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482213038",
            "country_code": "US",
            "telephone_number": "313-993-1245",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RIORDAN",
        "first_name": "MACKENZIE",
        "middle_name": "JOHNSON",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-08-11",
        "last_updated": "2026-09-11",
        "certification_date": "2026-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704405119",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704405119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2026; 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.