Provider Demographics
NPI:1598081614
Name:MCKENZIE, ISSEL MARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:ISSEL
Middle Name:MARIE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 LAKE WRIGHT DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-1859
Mailing Address - Country:US
Mailing Address - Phone:757-502-4840
Mailing Address - Fax:757-502-4841
Practice Address - Street 1:5700 LAKE WRIGHT DR
Practice Address - Street 2:SUITE 101
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-1859
Practice Address - Country:US
Practice Address - Phone:757-502-4840
Practice Address - Fax:757-502-4841
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168353363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
1326363417OtherFAMILY PRACTICE