Individual
MISS MACKENZIE LEE ICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, APRN, PMHNP-BC
Contact information
Practice address
6140 S BROADWAY, LORAIN, OH 44053
(440) 233-7232
Mailing address
6140 S BROADWAY, LORAIN, OH 44053-3821
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
435143
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
023025
OH
Other
Enumeration date
05/30/2018
Last updated
12/06/2018
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