Provider Demographics
NPI:1417559279
Name:MAKAREWICZ, LAURA K
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:K
Last Name:MAKAREWICZ
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 1:10021 BRIDGEPOINTE CT NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7405
Mailing Address - Country:US
Mailing Address - Phone:816-304-8847
Mailing Address - Fax:
Practice Address - Street 1:1501 SAN PEDRO DR SE BLDG 47
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-5180
Practice Address - Country:US
Practice Address - Phone:505-846-1483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered