Healthcare Provider Details

I. General information

NPI: 1205843869
Provider Name (Legal Business Name): LEZLIE LORRAINE MCKENZIE PMHCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715A SKYLA CT
MISSOULA MT
59801
US

IV. Provider business mailing address

715A SKYLA CT
MISSOULA MT
59801-1480
US

V. Phone/Fax

Practice location:
  • Phone: 406-543-2883
  • Fax: 406-543-2734
Mailing address:
  • Phone: 406-543-2883
  • Fax: 406-543-2734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN-LIC-99980
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: