Doctor Name: | LISA MAKARA |
NPI Number: | 1295152015 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | N.P. |
License Number: | 4704305988 |
Business Practice Address: | 1485 M 139 Benton Harbor, MI - 490225711 |
Business Phone Number: | 2699341611 |
Business Fax Number: | 2699271326 |
Mailing Address: | 1485 M 139, BENTON HARBOR |
State: | MI |
Postal Code: | 490225711 |
Phone Number: | 2699341611 |
Fax Number: | 2699271326 |
NPI Enumeration Date: | 03/19/2014 |
NPI Last Update Date: | 08/22/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0808X |
License Number: | 4704305988 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |