Provider Demographics
NPI:1093967242
Name:MULLER, MCKENZIE KAROLE (LPN)
Entity Type:Individual
Prefix:MS
First Name:MCKENZIE
Middle Name:KAROLE
Last Name:MULLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:MCKENZIE
Other - Middle Name:KAROLE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:10 GRENELL DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-4605
Mailing Address - Country:US
Mailing Address - Phone:585-615-9843
Mailing Address - Fax:
Practice Address - Street 1:10 GRENELL DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-4605
Practice Address - Country:US
Practice Address - Phone:585-615-9843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266950164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse