Doctor Name: | MS. NICHOLE JANELLE MCKENZIE |
NPI Number: | 1336292820 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 820 E Gilbert St San Bernardino, CA - 924150002 |
Business Phone Number: | 9093877200 |
Business Fax Number: | |
Mailing Address: | 850 E Foothill Blvd, RIALTO |
State: | CA |
Postal Code: | 923765230 |
Phone Number: | 9098734465 |
Fax Number: | |
NPI Enumeration Date: | 01/19/2007 |
NPI Last Update Date: | 07/09/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |