Provider Demographics
NPI:1104327766
Name:ANDREAN, MAKKEL MARIE (DAC, ATC)
Entity type:Individual
Prefix:DR
First Name:MAKKEL
Middle Name:MARIE
Last Name:ANDREAN
Suffix:
Gender:F
Credentials:DAC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 E 1ST PL
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-8920
Mailing Address - Country:US
Mailing Address - Phone:480-620-8798
Mailing Address - Fax:
Practice Address - Street 1:2915 E BASELINE RD STE 126
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2475
Practice Address - Country:US
Practice Address - Phone:480-620-8798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
AZ011995171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer