Provider Demographics
NPI:1083472096
Name:CHENEY MAKENS, ELISE ASTRID
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:ASTRID
Last Name:CHENEY MAKENS
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 1:313 LAFAYETTE AVE NE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3308
Mailing Address - Country:US
Mailing Address - Phone:906-231-4751
Mailing Address - Fax:
Practice Address - Street 1:313 LAFAYETTE AVE NE UNIT 2
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3308
Practice Address - Country:US
Practice Address - Phone:906-231-4751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program