Provider Demographics
NPI:1932344751
Name:EMRICK, MACKENZIE ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:MACKENZIE
Middle Name:ANN
Last Name:EMRICK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:ANN
Other - Last Name:EMRICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:123 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-3220
Mailing Address - Country:US
Mailing Address - Phone:937-541-9489
Mailing Address - Fax:
Practice Address - Street 1:123 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-3220
Practice Address - Country:US
Practice Address - Phone:937-541-9489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN123038 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse