Provider Demographics
NPI:1326533084
Name:MCKINNEY, LELA RENAE
Entity Type:Individual
Prefix:
First Name:LELA
Middle Name:RENAE
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 AMITY AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3710
Mailing Address - Country:US
Mailing Address - Phone:231-286-5327
Mailing Address - Fax:
Practice Address - Street 1:1175 WESLEY AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-2100
Practice Address - Country:US
Practice Address - Phone:231-220-2344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other