Individual
MRS. NISHA KIMBERLY MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
630 KENMOOR AVE SE STE 103, GRAND RAPIDS, MI 49546-8626
(616) 600-4950
(855) 817-3028
Mailing address
630 KENMOOR AVE SE STE 103, GRAND RAPIDS, MI 49546-8626
(616) 600-4950
(855) 817-3028
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601003946
MI
Other
Enumeration date
09/16/2005
Last updated
09/18/2020
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