Provider Demographics
NPI:1588263248
Name:MAKON AMAZING GIFTED HANDS PLLC
Entity type:Organization
Organization Name:MAKON AMAZING GIFTED HANDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGNP-BC, WCC, PMHNP-BC
Authorized Official - Prefix:MISS
Authorized Official - First Name:ROSETTE
Authorized Official - Middle Name:SANDRINE
Authorized Official - Last Name:MAKON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:469-989-2697
Mailing Address - Street 1:510 E MARDON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-1276
Mailing Address - Country:US
Mailing Address - Phone:469-989-2697
Mailing Address - Fax:725-205-5617
Practice Address - Street 1:3430 E FLAMINGO RD STE 350
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5067
Practice Address - Country:US
Practice Address - Phone:469-989-2697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty