Provider Demographics
NPI:1295556041
Name:KORHORN, MCKENZIE LYNN
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:LYNN
Last Name:KORHORN
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 1:5301 TALL OAKS CT
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-5754
Mailing Address - Country:US
Mailing Address - Phone:815-651-0584
Mailing Address - Fax:
Practice Address - Street 1:24W500 MAPLE AVE STE 214
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6057
Practice Address - Country:US
Practice Address - Phone:630-474-5321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164009765133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered