Provider Demographics
NPI:1932500782
Name:MAKUKA, JILL N (PA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:N
Last Name:MAKUKA
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Gender:F
Credentials:PA
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Mailing Address - Street 1:1131 S CLIFTON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2955
Mailing Address - Country:US
Mailing Address - Phone:316-462-1040
Mailing Address - Fax:316-462-1042
Practice Address - Street 1:1131 S CLIFTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2955
Practice Address - Country:US
Practice Address - Phone:316-462-1040
Practice Address - Fax:316-462-1042
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2017-06-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant