Provider Demographics
NPI:1760103907
Name:AKABA, MAUREEN N
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:N
Last Name:AKABA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30113 SPARKLEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2076
Mailing Address - Country:US
Mailing Address - Phone:248-227-5924
Mailing Address - Fax:
Practice Address - Street 1:30113 SPARKLEBERRY DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2076
Practice Address - Country:US
Practice Address - Phone:248-227-5924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704264496363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily