Healthcare Provider Details

I. General information

NPI: 1831790708
Provider Name (Legal Business Name): MAKENZIE KAYLA DUNLAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 LEWISTON RD
DAYTON OH
45429-2617
US

IV. Provider business mailing address

421 LEWISTON RD
KETTERING OH
45429-2617
US

V. Phone/Fax

Practice location:
  • Phone: 937-926-5118
  • Fax:
Mailing address:
  • Phone: 937-926-5118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: