Basic Information
| Provider Information | |||||||||
| NPI: | 1144956509 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEAR | ||||||||
| FirstName: | MCKENZIE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | APRN, CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3042 RAVINEVIEW CIR | ||||||||
| Address2: | |||||||||
| City: | STOW | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442245539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308588722 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2951 MAPLE AVE | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437011406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404554925 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2022 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APRN.CNP.0031846 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.