Provider Demographics
NPI:1073276168
Name:MCKENZIE, ERICA L
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:L
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 IVANHILL RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-5238
Mailing Address - Country:US
Mailing Address - Phone:419-322-5329
Mailing Address - Fax:
Practice Address - Street 1:100 IVANHILL RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-5238
Practice Address - Country:US
Practice Address - Phone:419-322-5329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide