Provider Demographics
NPI:1578233714
Name:GALE, MCKENZIE (DNP, ARNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:GALE
Suffix:
Gender:F
Credentials:DNP, ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 W IRONWOOD DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2643
Mailing Address - Country:US
Mailing Address - Phone:208-667-2600
Mailing Address - Fax:208-625-7114
Practice Address - Street 1:920 W IRONWOOD DR STE 200
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2643
Practice Address - Country:US
Practice Address - Phone:208-667-2600
Practice Address - Fax:208-625-2051
Is Sole Proprietor?:No
Enumeration Date:2021-09-19
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60854066163W00000X
ID70604363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID578233714Medicaid