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General NPI Number Information
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NPI Number | 1710415856
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Entity Type | Individual
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Provider Name | MCKENZI LANE STANDARD MD
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Gender | Female
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Dates
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Enumeration Date | 06/02/2017
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 7336 N CLASSEN BLVD # 200
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-7114
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Country | US
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Telephone | 405-285-8823
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Fax | 405-285-8824
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Provider Business Mailing Address
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Address Line | 7336 N CLASSEN BLVD # 200
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-7114
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Country | US
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Telephone | 405-285-8823
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Fax | 405-285-8824
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 33024
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License Number State | OK
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