Provider Demographics
NPI:1891502639
Name:GRANT, MCKENZIE (BSN, RN)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 FINN ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1012
Mailing Address - Country:US
Mailing Address - Phone:651-962-6750
Mailing Address - Fax:
Practice Address - Street 1:35 FINN ST S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1012
Practice Address - Country:US
Practice Address - Phone:651-962-6750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2516298163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse