Provider Demographics
NPI:1235693318
Name:MAKOWSKI, JACQUELINE
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:
Last Name:MAKOWSKI
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 1:33722 BROKAW RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA STATION
Mailing Address - State:OH
Mailing Address - Zip Code:44028-9778
Mailing Address - Country:US
Mailing Address - Phone:440-623-2155
Mailing Address - Fax:
Practice Address - Street 1:33722 BROKAW RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA STATION
Practice Address - State:OH
Practice Address - Zip Code:44028-9778
Practice Address - Country:US
Practice Address - Phone:440-623-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant