Provider Demographics
NPI:1619693462
Name:MAKANA, STELLAH KWAMBOKA (RN)
Entity Type:Individual
Prefix:
First Name:STELLAH
Middle Name:KWAMBOKA
Last Name:MAKANA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2552 TIFFANY LN
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-8627
Mailing Address - Country:US
Mailing Address - Phone:717-712-2350
Mailing Address - Fax:
Practice Address - Street 1:3544 N PROGRESS AVE STE 104
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9480
Practice Address - Country:US
Practice Address - Phone:717-652-3199
Practice Address - Fax:717-690-3611
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN641196163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103488349-0001Medicaid