Provider Demographics
NPI:1407922263
Name:MCKENZIE, SERENA MATEA (ND)
Entity Type:Individual
Prefix:DR
First Name:SERENA
Middle Name:MATEA
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13126 120TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3014
Mailing Address - Country:US
Mailing Address - Phone:425-398-9355
Mailing Address - Fax:425-453-2827
Practice Address - Street 1:12815 120TH AVE NE STE E
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3003
Practice Address - Country:US
Practice Address - Phone:425-398-9355
Practice Address - Fax:425-453-2827
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAND00000000001319175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2035355Medicaid