Provider Demographics
NPI:1508322231
Name:MAKINO, AKIKO ISHIDA (CRNP)
Entity Type:Individual
Prefix:MS
First Name:AKIKO
Middle Name:ISHIDA
Last Name:MAKINO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6509 SUGAR CREEK DR N
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-2734
Mailing Address - Country:US
Mailing Address - Phone:323-947-3380
Mailing Address - Fax:
Practice Address - Street 1:75 S UNIVERSITY BLVD # 6000A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3042
Practice Address - Country:US
Practice Address - Phone:251-660-5787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-159141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-159141OtherALABAMA BOARD OF NURSING