Provider Demographics
NPI:1689378812
Name:MCKENZIE, NATINA ANGELA (SELF)
Entity Type:Individual
Prefix:MISS
First Name:NATINA
Middle Name:ANGELA
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:SELF
Other - Prefix:MISS
Other - First Name:NATINA
Other - Middle Name:ANGELA
Other - Last Name:BOONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1415 SOUTHERN AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-4346
Mailing Address - Country:US
Mailing Address - Phone:202-550-5654
Mailing Address - Fax:202-462-2309
Practice Address - Street 1:1415 SOUTHERN AVE APT 304
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-4346
Practice Address - Country:US
Practice Address - Phone:202-550-5654
Practice Address - Fax:202-462-2309
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician