Provider Demographics
NPI:1699820183
Name:MAKI, MARCELLA G (BSN, RN)
Entity Type:Individual
Prefix:
First Name:MARCELLA
Middle Name:G
Last Name:MAKI
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:MARCELLA
Other - Middle Name:
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:240 W TYRONE RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6517
Mailing Address - Country:US
Mailing Address - Phone:865-482-1076
Mailing Address - Fax:865-481-6179
Practice Address - Street 1:240 W TYRONE RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6517
Practice Address - Country:US
Practice Address - Phone:865-482-1076
Practice Address - Fax:865-481-6179
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41553163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse