Provider Demographics
NPI:1841608940
Name:MCKENZIE, MARY ANNA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANNA
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8409 155TH AVE
Mailing Address - Street 2:APT. 3D
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-2219
Mailing Address - Country:US
Mailing Address - Phone:917-279-7240
Mailing Address - Fax:
Practice Address - Street 1:8409 155TH AVE
Practice Address - Street 2:APT. 3D
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2219
Practice Address - Country:US
Practice Address - Phone:917-279-7240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY511002-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY511002-1OtherNURSING SERVICE PROVIDERS