Provider Demographics
NPI:1003069972
Name:MAKOMBESE, ROSINA
Entity type:Individual
Prefix:MISS
First Name:ROSINA
Middle Name:
Last Name:MAKOMBESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSINA
Other - Middle Name:
Other - Last Name:MAKOMBESE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:11212 208TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2206
Mailing Address - Country:US
Mailing Address - Phone:718-465-3786
Mailing Address - Fax:
Practice Address - Street 1:11212 208TH ST
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-2206
Practice Address - Country:US
Practice Address - Phone:718-465-3786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289126164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse