Healthcare Provider Details

I. General information

NPI: 1366896128
Provider Name (Legal Business Name): MCKENZIE VATER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 12/24/2024
Certification Date: 12/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 4010
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVE ML 4010
NASHVILLE OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4676
  • Fax: 513-636-5568
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number59270
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number35.151818
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: