Individual
MR. MICAH PEARCE MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3901 S 7TH ST, TERRE HAUTE, IN 47802-5709
(727) 437-3530
(727) 498-1159
Mailing address
4024 S WILLOWBROOK CT, TERRE HAUTE, IN 47802-8871
(801) 884-3325
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28213679A
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
28213679A
IN
Other
Enumeration date
04/18/2014
Last updated
05/14/2014
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