Provider Demographics
NPI:1972830727
Name:MCKENZIE, ELINORE A
Entity Type:Individual
Prefix:
First Name:ELINORE
Middle Name:A
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 VIRGINIA TER
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53726-5342
Mailing Address - Country:US
Mailing Address - Phone:608-347-5295
Mailing Address - Fax:
Practice Address - Street 1:216 VIRGINIA TER
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53726-5342
Practice Address - Country:US
Practice Address - Phone:608-347-5295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-14
Last Update Date:2009-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program