Provider Demographics
NPI:1386392751
Name:MCKENZIE, CLAIRE PATRICE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:PATRICE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8507 OXON HILL RD STE 200S-3
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-4766
Mailing Address - Country:US
Mailing Address - Phone:301-806-0307
Mailing Address - Fax:
Practice Address - Street 1:8507 OXON HILL RD STE 200S-3
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4766
Practice Address - Country:US
Practice Address - Phone:301-806-0307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR205022163WC1500X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty