Provider Demographics
NPI:1073932422
Name:MACKENZIE, TERRY (RN)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 SAINT THOMAS DR
Mailing Address - Street 2:#308
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2138
Mailing Address - Country:US
Mailing Address - Phone:619-454-1934
Mailing Address - Fax:
Practice Address - Street 1:2009 SAINT THOMAS DR
Practice Address - Street 2:#308
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2138
Practice Address - Country:US
Practice Address - Phone:619-454-1934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR076524163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management