Provider Demographics
NPI:1891585089
Name:VAN HOY, MCKENZIE NICHOLS (IBCLC)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:NICHOLS
Last Name:VAN HOY
Suffix:
Gender:
Credentials:IBCLC
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IBCLC
Mailing Address - Street 1:2584 NW ALICE KELLEY ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-2804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2584 NW ALICE KELLEY ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-2804
Practice Address - Country:US
Practice Address - Phone:503-434-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201041448RN163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant