Provider Demographics
NPI:1942987524
Name:MAIDEN, MAKINZE
Entity Type:Individual
Prefix:
First Name:MAKINZE
Middle Name:
Last Name:MAIDEN
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 1:6905 KENNEMER DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-9595
Mailing Address - Country:US
Mailing Address - Phone:605-593-7801
Mailing Address - Fax:
Practice Address - Street 1:6905 KENNEMER DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-9595
Practice Address - Country:US
Practice Address - Phone:605-593-7801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant