Provider Demographics
NPI:1588671028
Name:MCKENZIE, ANGELA (ND, LM, CPM)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:ND, LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 GREGORY ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1729
Mailing Address - Country:US
Mailing Address - Phone:608-258-2525
Mailing Address - Fax:
Practice Address - Street 1:3621 GREGORY ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1729
Practice Address - Country:US
Practice Address - Phone:608-258-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1020175F00000X
MN1073175F00000X
WI6030-170175F00000X
WI49-152176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No176B00000XOther Service ProvidersMidwife