Provider Demographics
NPI:1720736838
Name:MCKENZIE, ANNEKA TIFFANY (RN)
Entity Type:Individual
Prefix:MISS
First Name:ANNEKA
Middle Name:TIFFANY
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 1:3580 BRECKENRIDGE CT APT 13
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53713-3675
Mailing Address - Country:US
Mailing Address - Phone:954-240-6316
Mailing Address - Fax:
Practice Address - Street 1:SELECT SPECIALTY HOSPITAL
Practice Address - Street 2:801 BRAXTON PLACE
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715
Practice Address - Country:US
Practice Address - Phone:608-260-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI247142-30163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical