Individual
MRS. MCKENZIE MACK LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3001 BROADMOOR BLVD NE, RIO RANCHO, NM 87144-2100
(505) 550-9863
Mailing address
2225 DELFINIO DR SE, RIO RANCHO, NM 87124-2947
(505) 550-9863
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP-02964
NM
Other
Enumeration date
07/26/2016
Last updated
10/02/2023
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