Provider Demographics
NPI:1811799570
Name:COYNE, MACKENZIE LANE
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:LANE
Last Name:COYNE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 GLEN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8079
Mailing Address - Country:US
Mailing Address - Phone:740-602-3374
Mailing Address - Fax:
Practice Address - Street 1:4620 GLEN LAKES DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-8079
Practice Address - Country:US
Practice Address - Phone:740-602-3374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program