Provider Demographics
NPI:1730436577
Name:MCKENZIE, MARY DEAN (LPN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:DEAN
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 PARK AVE
Mailing Address - Street 2:12G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-5255
Mailing Address - Country:US
Mailing Address - Phone:347-645-9536
Mailing Address - Fax:
Practice Address - Street 1:760 PARK AVE
Practice Address - Street 2:12G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5255
Practice Address - Country:US
Practice Address - Phone:347-645-9536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-11
Last Update Date:2012-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270326-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse