1669387650 NPI number — MACKENZIE ELAINE HAGSTROM RN,BSN

Table of content: MACKENZIE ELAINE HAGSTROM RN,BSN (NPI 1669387650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669387650 NPI number — MACKENZIE ELAINE HAGSTROM RN,BSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAGSTROM
Provider First Name:
MACKENZIE
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN,BSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669387650
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3170 KIRWIN AVE
Provider Second Line Business Mailing Address:
1005
Provider Business Mailing Address City Name:
MISSISSAUGA
Provider Business Mailing Address State Name:
ON
Provider Business Mailing Address Postal Code:
L5A3R1
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3170 KIRWIN AVE
Provider Second Line Business Practice Location Address:
1005
Provider Business Practice Location Address City Name:
MISSISSAUGA
Provider Business Practice Location Address State Name:
ON
Provider Business Practice Location Address Postal Code:
L5A3R1
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2026

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , with the licence number:  95095190 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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