Provider Demographics
NPI:1568978781
Name:MCKENZIE, MONA (LVN)
Entity Type:Individual
Prefix:MS
First Name:MONA
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 ARUBA CALLE
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-5497
Mailing Address - Country:US
Mailing Address - Phone:409-218-4575
Mailing Address - Fax:
Practice Address - Street 1:2114 ARUBA CALLE
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-5497
Practice Address - Country:US
Practice Address - Phone:409-218-4575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX185345164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse