Provider Demographics
NPI:1265140719
Name:HERWALD, MCKENZIE MAE (RN)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:MAE
Last Name:HERWALD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:MAE
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5011 FRIENDSHIP AVE APT A
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1701
Mailing Address - Country:US
Mailing Address - Phone:412-680-9455
Mailing Address - Fax:
Practice Address - Street 1:4800 FRIENDSHIP AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1793
Practice Address - Country:US
Practice Address - Phone:412-578-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA750199163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine