Provider Demographics
NPI:1235309238
Name:LEZLIE L MCKENZIE MSN APRN BC PLLC
Entity Type:Organization
Organization Name:LEZLIE L MCKENZIE MSN APRN BC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETORSHIP
Authorized Official - Prefix:
Authorized Official - First Name:LEZLIE
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHCNS
Authorized Official - Phone:406-543-2883
Mailing Address - Street 1:715A SKYLA CT
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-1480
Mailing Address - Country:US
Mailing Address - Phone:406-543-2883
Mailing Address - Fax:406-543-2734
Practice Address - Street 1:715A SKYLA CT
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801
Practice Address - Country:US
Practice Address - Phone:406-543-2883
Practice Address - Fax:406-543-2734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty