Basic Information
| Provider Information | |||||||||
| NPI: | 1699098749 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKENZIE | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | DOUGLAS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RN, BSN, MSN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2114 LIGHTHOUSE DR | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945341853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074262239 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4700 NORTHGATE BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958341128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169296161 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2010 | ||||||||
| LastUpdateDate: | 03/03/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 296107 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.