Provider Demographics
NPI:1386418374
Name:MAKULA, ANNIE ALISSA
Entity type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:ALISSA
Last Name:MAKULA
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 1:14025 DEFIANCE PIKE
Mailing Address - Street 2:
Mailing Address - City:RUDOLPH
Mailing Address - State:OH
Mailing Address - Zip Code:43462-9718
Mailing Address - Country:US
Mailing Address - Phone:419-601-8244
Mailing Address - Fax:
Practice Address - Street 1:14025 DEFIANCE PIKE
Practice Address - Street 2:
Practice Address - City:RUDOLPH
Practice Address - State:OH
Practice Address - Zip Code:43462-9718
Practice Address - Country:US
Practice Address - Phone:419-601-8244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide