Provider Demographics
NPI:1659558781
Name:MCKENZIE, REBECCA C (APRN-NP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:C
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:APRN-NP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:C
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-NP
Mailing Address - Street 1:8111 DODGE ST
Mailing Address - Street 2:SUITE 363
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4129
Mailing Address - Country:US
Mailing Address - Phone:402-934-6504
Mailing Address - Fax:402-934-6518
Practice Address - Street 1:8111 DODGE ST
Practice Address - Street 2:SUITE 363
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4129
Practice Address - Country:US
Practice Address - Phone:402-934-6504
Practice Address - Fax:402-934-6518
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47037975436Medicaid