MEDICARE: MCKENZIE REGAN LIKES APN-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SE0003X	Emergency Clinical Nurse Specialist	209.011797	IL

General Provider Information

NPI Number	:	1104227677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKENZIE REGAN LIKES APN-C

Provider Business Mailing Address
First Line	:	DEPT 960347
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73196-0347
Country	:	US
Telephone Number	:	800-684-0062
Fax Number	:	405-844-1794

Provider Business Practice Location Address
First Line	:	221 NE GLEN OAK AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61636-0001
Country	:	US
Telephone Number	:	309-672-5522
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2014
Last Update Date	:	09/15/2014

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Directions to “ MCKENZIE REGAN LIKES APN-C” Practice Location

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