Individual
MEKENZIE SPENCER JOHNSTON KMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
930 SW ABBEY ST, NEWPORT, OR 97365-4820
(541) 265-2244
(541) 574-1838
Mailing address
313 SE 116TH ST, SOUTH BEACH, OR 97366-9729
(206) 399-3404
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
D127901
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127901
RN
IA
05
—
500649068
—
OR
01
—
D-127901
ARNP
IA
Enumeration date
07/11/2011
Last updated
03/15/2016
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