Healthcare Provider Details

I. General information

NPI: 1235309238
Provider Name (Legal Business Name): LEZLIE L MCKENZIE MSN APRN BC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 04/12/2019
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 Number
License Number State

VIII. Authorized Official

Name: LEZLIE LORRAINE MCKENZIE
Title or Position: SOLE PROPRIETORSHIP
Credential: PMHCNS
Phone: 406-543-2883