Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mackenzie Brooke Pung

Individual provider Acute Care Nurse Practitioner · NPI 1376320424

Mackenzie Brooke Pung is a Nurse Practitioner in Grand Rapids, Michigan. Qualified in 2022, 4 years ago. Practices with Impg PLLC, a 6-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
4
Licensed in
MI
In the registry since
2023
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Practice location Address checks out

770 Kenmoor Ave SE Ste 100
Grand Rapids, MI 49546-8602
Phone: (616) 259-3533
Fax: (616) 259-4839
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence 4704351413 (MI)

Record details

NPI number1376320424
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedSeptember 12, 2023
Last updated in NPPESOctober 1, 2025
Certification dateOctober 1, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Impg Pllc — 6 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Grand Rapids