Provider Demographics
NPI:1518137934
Name:MAKIT ANESTHESIA INC
Entity Type:Organization
Organization Name:MAKIT ANESTHESIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT CRNA
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COPENHAVER-MACKOWIAK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:304-872-9066
Mailing Address - Street 1:PO BOX 1012
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-1012
Mailing Address - Country:US
Mailing Address - Phone:304-647-4570
Mailing Address - Fax:304-872-9066
Practice Address - Street 1:101 OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:CANVAS
Practice Address - State:WV
Practice Address - Zip Code:26662-0109
Practice Address - Country:US
Practice Address - Phone:304-872-9066
Practice Address - Fax:304-872-9066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty