MEDICARE: MCKENZIE BROOKLIN NAVA PMHNP-BC, DNP, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	406269	NY
2	163W00000X	Registered Nurse	853799	NY

General Provider Information

NPI Number	:	1932819430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKENZIE BROOKLIN NAVA PMHNP-BC, DNP, RN

Provider Business Mailing Address
First Line	:	2791 FREDERICK DOUGLASS BLVD
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10039-3006
Country	:	US
Telephone Number	:	917-858-6291
Fax Number	:	718-304-1605

Provider Business Practice Location Address
First Line	:	2791 FREDERICK DOUGLASS BLVD
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10039-3006
Country	:	US
Telephone Number	:	917-858-6291
Fax Number	:	718-304-1605

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2022
Last Update Date	:	07/24/2025

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