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General NPI Number Information
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NPI Number | 1437898863
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Entity Type | Individual
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Provider Name | LISA L MCKENZIE RN
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Gender | Female
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Dates
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Enumeration Date | 06/02/2022
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Last Update Date | 06/02/2022
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Provider Practice Location Address
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Address Line | 690 BARNES BLVD
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City | JOINT BASE LEWIS MCCHORD
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State | WA
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Zip | 98438-1303
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Country | US
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Telephone | 253-982-0650
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Fax |
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Provider Business Mailing Address
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Address Line | 11514 104TH AVE SW APT D
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City | LAKEWOOD
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State | WA
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Zip | 98498-1368
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Country | US
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Telephone | 253-448-0778
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | RN00106926
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License Number State | WA
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