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NPI Code Detail

MEDICARE: LAURIE MCKENZIE WHITE ATC

MEDICARE: LAURIE MCKENZIE WHITE ATC
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
12255A2300XAthletic Trainer000136AZ

General Provider Information

NPI Number : 1811533094
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURIE MCKENZIE WHITE ATC
Provider Business Mailing Address
First Line : 4710 N 5TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-1738
Country : US
Telephone Number : 602-240-3119
Fax Number :
Provider Business Practice Location Address
First Line : 4710 N 5TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-1738
Country : US
Telephone Number : 602-240-3119
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2019
Last Update Date : 11/21/2019

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Directions to “ LAURIE MCKENZIE WHITE ATC” Practice Location

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