Provider Demographics
NPI:1346854593
Name:MCKENZIE, DEBRA KAY
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:KAY
Last Name:MCKENZIE
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 1:6840 BRUSH LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LEWISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43060-9621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6840 BRUSH LAKE RD
Practice Address - Street 2:
Practice Address - City:NORTH LEWISBURG
Practice Address - State:OH
Practice Address - Zip Code:43060-9621
Practice Address - Country:US
Practice Address - Phone:937-407-6730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider