Healthcare Provider Details

I. General information

NPI: 1588671028
Provider Name (Legal Business Name): ANGELA MCKENZIE ND, LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3621 GREGORY ST
MADISON WI
53711-1729
US

IV. Provider business mailing address

3621 GREGORY ST
MADISON WI
53711-1729
US

V. Phone/Fax

Practice location:
  • Phone: 608-258-2525
  • Fax:
Mailing address:
  • Phone: 608-258-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1020
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1073
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number6030-170
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number49-152
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: