Provider Demographics
NPI:1013504851
Name:KELLOGG, MAKENDRA MARIE
Entity type:Individual
Prefix:
First Name:MAKENDRA
Middle Name:MARIE
Last Name:KELLOGG
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 1:506 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:KENNARD
Mailing Address - State:NE
Mailing Address - Zip Code:68034-5193
Mailing Address - Country:US
Mailing Address - Phone:402-870-2208
Mailing Address - Fax:
Practice Address - Street 1:506 MAPLE ST
Practice Address - Street 2:
Practice Address - City:KENNARD
Practice Address - State:NE
Practice Address - Zip Code:68034-5193
Practice Address - Country:US
Practice Address - Phone:402-870-2208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE119515376K00000X
3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376K00000XNursing Service Related ProvidersNurse's Aide