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General NPI Number Information
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NPI Number | 1609516111
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Entity Type | Individual
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Provider Name | PAIGE TAYLOR MCKENZIE MS
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Gender | Female
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Dates
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Enumeration Date | 03/31/2022
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Last Update Date | 07/24/2024
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Provider Practice Location Address
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Address Line | 8701 WATERTOWN PLANK RD
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City | MILWAUKEE
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State | WI
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Zip | 53226-3548
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Country | US
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Telephone | 414-955-8990
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Fax | 414-955-6299
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Provider Business Mailing Address
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Address Line | 34700 VALLEY RD
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City | OCONOMOWOC
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State | WI
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Zip | 53066-4500
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Country | US
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Telephone | 262-646-4411
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 82463-20
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License Number State | WI
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