Provider Demographics
NPI:1386012920
Name:MAKI, MOLLY BRIDGET (MSN, RN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:BRIDGET
Last Name:MAKI
Suffix:
Gender:F
Credentials:MSN, RN, FNP-BC
Other - Prefix:MS
Other - First Name:MOLLY
Other - Middle Name:BRIDGET
Other - Last Name:RUHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, RN, FNP-BC
Mailing Address - Street 1:1135 W UNIVERSITY DR STE 425
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1897
Mailing Address - Country:US
Mailing Address - Phone:248-650-5864
Mailing Address - Fax:248-650-5865
Practice Address - Street 1:1135 W UNIVERSITY DR
Practice Address - Street 2:SUITE 425
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1871
Practice Address - Country:US
Practice Address - Phone:248-650-5861
Practice Address - Fax:248-650-5865
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704274546363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner