Provider Demographics
NPI:1881010510
Name:MAKI, BERKLEY (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:BERKLEY
Middle Name:
Last Name:MAKI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:BERKLEY
Other - Middle Name:
Other - Last Name:KOESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:877 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2807
Mailing Address - Country:US
Mailing Address - Phone:901-545-6286
Mailing Address - Fax:901-545-8122
Practice Address - Street 1:877 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2807
Practice Address - Country:US
Practice Address - Phone:901-545-6286
Practice Address - Fax:901-545-8122
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2312583367500000X
VA0024171509367500000X
TN28535367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered