Provider Demographics
NPI:1518377282
Name:MUSHATI-MAKOKO, LAUREEN (NP-C)
Entity Type:Individual
Prefix:
First Name:LAUREEN
Middle Name:
Last Name:MUSHATI-MAKOKO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5933 LAKE CYRUS DR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4163
Mailing Address - Country:US
Mailing Address - Phone:256-457-6397
Mailing Address - Fax:
Practice Address - Street 1:5933 LAKE CYRUS DR
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4163
Practice Address - Country:US
Practice Address - Phone:256-457-6397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-109952363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner