Provider Demographics
NPI:1811150634
Name:MCKENZIE, WILLIAM MICHAEL (LPN)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4135 WALNUT RD
Mailing Address - Street 2:LOT # 176
Mailing Address - City:BUCKEYE LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:43008-2101
Mailing Address - Country:US
Mailing Address - Phone:321-720-3905
Mailing Address - Fax:
Practice Address - Street 1:4135 WALNUT RD
Practice Address - Street 2:LOT # 176
Practice Address - City:BUCKEYE LAKE
Practice Address - State:OH
Practice Address - Zip Code:43008-2101
Practice Address - Country:US
Practice Address - Phone:321-720-3905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 109001164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse