Provider Demographics
NPI:1447450325
Name:MCKENZIE, ANGELA MAXINE (LPN)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MAXINE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 WILDBOAR CT
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-2192
Mailing Address - Country:US
Mailing Address - Phone:770-306-2011
Mailing Address - Fax:770-306-2011
Practice Address - Street 1:645 WILDBOAR CT
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-2192
Practice Address - Country:US
Practice Address - Phone:770-306-2011
Practice Address - Fax:770-306-2011
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN070160164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse