Provider Demographics
NPI:1225693229
Name:MAKUAKANE, JENNIFER (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MAKUAKANE
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Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3130 W MAPLE LOOP DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5672
Mailing Address - Country:US
Mailing Address - Phone:385-600-6367
Mailing Address - Fax:855-749-6881
Practice Address - Street 1:3130 W MAPLE LOOP DR STE 110
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5790
Practice Address - Country:US
Practice Address - Phone:385-600-6367
Practice Address - Fax:855-749-6881
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2024-04-09
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant