Provider Demographics
NPI:1346392610
Name:MCKENZIE, MARIAN H (CNP)
Entity Type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:H
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 E AZTEC
Mailing Address - Street 2:#6
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301
Mailing Address - Country:US
Mailing Address - Phone:505-863-9374
Mailing Address - Fax:505-722-7400
Practice Address - Street 1:1808 E AZTEC
Practice Address - Street 2:#6
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301
Practice Address - Country:US
Practice Address - Phone:505-863-9374
Practice Address - Fax:505-722-7400
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR18676363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM11858Medicaid
S13963Medicare UPIN