Healthcare Provider Details

I. General information

NPI: 1578233714
Provider Name (Legal Business Name): MCKENZIE GALE DNP, ARNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2021
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 W CANFIELD AVE
COEUR D ALENE ID
83815-9764
US

IV. Provider business mailing address

919 W CANFIELD AVE
COEUR D ALENE ID
83815-9764
US

V. Phone/Fax

Practice location:
  • Phone: 208-758-0560
  • Fax: 208-762-5424
Mailing address:
  • Phone: 208-758-0560
  • Fax: 208-762-5424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number70604
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60854066
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: