Healthcare Provider Details

I. General information

NPI: 1558784306
Provider Name (Legal Business Name): CAITLYN MCKENZIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 BURNET AVE
CINCINNATI OH
45229-3014
US

IV. Provider business mailing address

3101 BURNET AVE
CINCINNATI OH
45229-3014
US

V. Phone/Fax

Practice location:
  • Phone: 513-352-3037
  • Fax:
Mailing address:
  • Phone: 513-352-3037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN390098
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: