Individual
MS. DIANE E MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
11200 W LINCOLN HWY, MOKENA, IL 60448-8208
(815) 464-2171
(815) 464-2176
Mailing address
12311 S MORGAN ST, CALUMET PARK, IL 60827-6222
(708) 396-2820
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209003923
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209003923
—
IL
Enumeration date
10/03/2006
Last updated
06/13/2011
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