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NPI Code Detail

MEDICARE: MCKENZI FREDERICK RN

MEDICARE: MCKENZI FREDERICK RN
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
1163W00000XRegistered Nurse041501632IL

General Provider Information

NPI Number : 1104588326
Entity Type Code : Individual
Provider Name (Legal Business Name) : MCKENZI FREDERICK RN
Provider Business Mailing Address
First Line : 4241 HIGHWAY 14 W
Second Line :
City : CHRISTOPHER
State : IL
Zip : 62822-1037
Country : US
Telephone Number : 618-724-1684
Fax Number :
Provider Business Practice Location Address
First Line : 165 KINNAMAN DR
Second Line :
City : FLORA
State : IL
Zip : 62839-4204
Country : US
Telephone Number : 618-662-8386
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2021
Last Update Date : 10/06/2021

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Directions to “ MCKENZI FREDERICK RN” Practice Location

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