Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 44537 | AZ |
N | 207N00000X | Dermatologist | ML20008852 | WA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 44537 | AZ |
N | 207ND0101X | MOHS-Micrographic Surgeon | MD60175612 | WA |
NPI | 1154513661 |
---|---|
Provider Name | Jill J Mckenzie |
First Address | Chandler, AZ 85286-6157 |
Second Address | Chandler, AZ 85286-6157 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2007 |
Last Update Date | 17/03/2018 |