Provider Demographics
NPI:1205652815
Name:BLINE, MACKENZIE CAITILIN
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:CAITILIN
Last Name:BLINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 E 51ST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-1166
Mailing Address - Country:US
Mailing Address - Phone:765-398-6207
Mailing Address - Fax:
Practice Address - Street 1:8902 N MERIDIAN ST STE 101
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5306
Practice Address - Country:US
Practice Address - Phone:317-848-8048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach