Mackenzie Nichole Black
Individual provider Active NPI Home Health Aide · Bryan, OH
NPI 1295599884 · NPPES record last updated Mar 4, 2024
Key facts
- NPI
- 1295599884
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Home Health Aide 374U00000X
- Practice address
- 936 E Wilson St Apt C4
Bryan, OH 43506-1860 - Phone
- (419) 799-2208
- NPI assigned
- Feb 13, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | Yes |
Addresses
Primary practice location
936 E Wilson St Apt C4
Bryan, OH 43506-1860
Mailing address
936 E Wilson St Apt C4
Bryan, OH 43506-1860
Phone (419) 799-2208
Other providers in Bryan, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.