Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | F401498 | NY |
NPI | 1033354014 |
---|---|
Provider Name | Hugh L.a Mckenzie |
First Address | Monroe, NY 10949-8574 |
Second Address | Newburgh, NY 12550-2693 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2008 |
Last Update Date | 18/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03722332 | (05) | NY |
W06181 | (02) | NY |