Provider Demographics
NPI:1235123837
Name:MCKENZIE, BRENDA KAY (MSN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 2335
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2055
Mailing Address - Country:US
Mailing Address - Phone:302-623-4285
Mailing Address - Fax:302-623-4155
Practice Address - Street 1:4701 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 2335
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2055
Practice Address - Country:US
Practice Address - Phone:302-623-4285
Practice Address - Fax:302-623-4155
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR137546363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily