Provider Demographics
NPI:1346547080
Name:MAKARUTSA, VERNA
Entity Type:Individual
Prefix:MRS
First Name:VERNA
Middle Name:
Last Name:MAKARUTSA
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 1:520 SKYLINE DR
Mailing Address - Street 2:APPT 16
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-6717
Mailing Address - Country:US
Mailing Address - Phone:978-888-4265
Mailing Address - Fax:978-710-7005
Practice Address - Street 1:520 SKYLINE DR
Practice Address - Street 2:APPT 16
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-6717
Practice Address - Country:US
Practice Address - Phone:978-888-4265
Practice Address - Fax:978-710-7005
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN86284164W00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No164W00000XNursing Service ProvidersLicensed Practical Nurse