Provider Demographics
NPI:1265101554
Name:MCKENZIE, JONI LEE (PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:JONI
Middle Name:LEE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3429 COURT WAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-5927
Mailing Address - Country:US
Mailing Address - Phone:410-440-2974
Mailing Address - Fax:
Practice Address - Street 1:3429 COURT WAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222-5927
Practice Address - Country:US
Practice Address - Phone:410-440-2974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date: