Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | AP30002100 | WA |
NPI | 1154419703 |
---|---|
Provider Name | Maureen M Mckenzie |
First Address | Lynnwood, WA 98036-4604 |
Second Address | Lynnwood, WA 98036-4604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
187939 | WORKERS COMPENSATION (01) | WA |
9614215 | (05) | WA |