Provider Demographics
NPI:1376145193
Name:MAKSE, EDIE A
Entity Type:Individual
Prefix:
First Name:EDIE
Middle Name:A
Last Name:MAKSE
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 1:37235 BEECH HILLS DR
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-6931
Mailing Address - Country:US
Mailing Address - Phone:440-463-3842
Mailing Address - Fax:
Practice Address - Street 1:37235 BEECH HILLS DR
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094-6931
Practice Address - Country:US
Practice Address - Phone:440-463-3842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.423597163W00000X
174200000X, 372500000X, 372600000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No163W00000XNursing Service ProvidersRegistered Nurse
No174200000XOther Service ProvidersMeals
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion