Provider Demographics
NPI:1326790924
Name:MCKENZIE, MARIA ROIDAN (CNP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ROIDAN
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MARIA ROIDAN
Other - Middle Name:MENDOZA
Other - Last Name:DEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1646 DARTMOUTH LN
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-3590
Mailing Address - Country:US
Mailing Address - Phone:234-233-0471
Mailing Address - Fax:
Practice Address - Street 1:3700 KOLBE RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1611
Practice Address - Country:US
Practice Address - Phone:440-960-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0030657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily