Individual
MRS. KELLY SUE MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
12500 WILLOWBROOK RD, WESTERN MD REGIONAL HEALTH SYSTEM, CUMBERLAND, MD 21502-6393
(240) 964-3306
Mailing address
11321 SNOW LINE DR NW, FROSTBURG, MD 21532
(301) 689-0436
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
049080
MD
367500000X
Certified Registered Nurse Anesthetist
51177
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
854129900
—
MD
Enumeration date
07/06/2006
Last updated
02/19/2019
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