Healthcare Provider Details

I. General information

NPI: 1598435406
Provider Name (Legal Business Name): SELINA MCKENZIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7827 HAMILTON AVE
CINCINNATI OH
45231-3175
US

IV. Provider business mailing address

7827 HAMILTON AVE
CINCINNATI OH
45231-3175
US

V. Phone/Fax

Practice location:
  • Phone: 513-386-7080
  • Fax:
Mailing address:
  • Phone: 513-550-5778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN.243587
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: