Provider Demographics
NPI:1093330201
Name:MCKENZIE, SHAINNA ALISE (APN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHAINNA
Middle Name:ALISE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:APN, FNP-C
Other - Prefix:MS
Other - First Name:SHAINNA
Other - Middle Name:ALISE
Other - Last Name:ISRAEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN,FNP-C
Mailing Address - Street 1:1 FEDERAL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:848-288-6935
Mailing Address - Fax:
Practice Address - Street 1:800 COOPER ST FL 4
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08102-1155
Practice Address - Country:US
Practice Address - Phone:856-342-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2023-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00999200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily