Provider Demographics
NPI:1114751922
Name:MCKENZIE, AMANDA MARIE (RN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 E BROAD ST FL 4
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2086
Mailing Address - Country:US
Mailing Address - Phone:614-655-3345
Mailing Address - Fax:
Practice Address - Street 1:6400 E BROAD ST FL 4
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2086
Practice Address - Country:US
Practice Address - Phone:614-655-3345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHRN.502483163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No171M00000XOther Service ProvidersCase Manager/Care Coordinator