1689378812 NPI number — MISS NATINA ANGELA MCKENZIE SELF

Table of content: MISS NATINA ANGELA MCKENZIE SELF (NPI 1689378812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689378812 NPI number — MISS NATINA ANGELA MCKENZIE SELF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKENZIE
Provider First Name:
NATINA
Provider Middle Name:
ANGELA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
SELF
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOONE
Provider Other First Name:
NATINA
Provider Other Middle Name:
ANGELA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689378812
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1415 SOUTHERN AVE APT 304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OXON HILL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20745-4346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-550-5654
Provider Business Mailing Address Fax Number:
202-462-2309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1415 SOUTHERN AVE APT 304
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXON HILL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20745-4346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-550-5654
Provider Business Practice Location Address Fax Number:
202-462-2309
Provider Enumeration Date:
03/30/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374700000X , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com