Provider Demographics
NPI:1669649398
Name:MACKENZIE, ANN E (LMP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:E
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 1ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1602
Mailing Address - Country:US
Mailing Address - Phone:509-289-0132
Mailing Address - Fax:
Practice Address - Street 1:150 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1602
Practice Address - Country:US
Practice Address - Phone:509-289-0132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024902174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist