Provider Demographics
NPI:1124412739
Name:MCINTYRE, MCKENIZE DAWN
Entity Type:Individual
Prefix:
First Name:MCKENIZE
Middle Name:DAWN
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MCKENIZE
Other - Middle Name:DAWN
Other - Last Name:MESSERSMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1209
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69103-1209
Mailing Address - Country:US
Mailing Address - Phone:308-532-4860
Mailing Address - Fax:308-532-1157
Practice Address - Street 1:110 N. BAILEY
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5436
Practice Address - Country:US
Practice Address - Phone:308-532-4860
Practice Address - Fax:308-532-1157
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator