Individual
MELISSA DIANA MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
37 PALMER ST STE 1, CALAIS, ME 04619-1341
(207) 454-7521
(207) 454-3616
Mailing address
424 WOODLAWN RD, GREENWOOD, SC 29646-9163
(828) 244-8380
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
3247
SC
363LP0200X
Pediatric Nurse Practitioner
5003497
NC
363LP0200X
Pediatric Nurse Practitioner
Primary
CNP201420
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP3680
—
SC
01
—
SCL446H895
MEDICARE PIN
SC
Enumeration date
06/14/2007
Last updated
12/01/2021
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