Healthcare Provider Details

I. General information

NPI: 1720736838
Provider Name (Legal Business Name): ANNEKA TIFFANY MCKENZIE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/17/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SELECT SPECIALTY HOSPITAL 801 BRAXTON PLACE
MADISON WI
53715
US

IV. Provider business mailing address

3580 BRECKENRIDGE CT APT 13
FITCHBURG WI
53713-3675
US

V. Phone/Fax

Practice location:
  • Phone: 608-260-2700
  • Fax:
Mailing address:
  • Phone: 954-240-6316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number247142-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: