Healthcare Provider Details

I. General information

NPI: 1679585640
Provider Name (Legal Business Name): MICHELLE ELIZABETH MCKENZIE M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO SE
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

4116 HENDRIX RD NE
ALBUQUERQUE NM
87110-1090
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax:
Mailing address:
  • Phone: 505-883-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: