Provider Demographics
NPI:1013687946
Name:MAKORI, EDNAH KWAMBOKA (NP)
Entity Type:Individual
Prefix:
First Name:EDNAH
Middle Name:KWAMBOKA
Last Name:MAKORI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:NOT APPLICABLE
Other - Middle Name:NOT APPLICABLE
Other - Last Name:NOT APPLICABLE.
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:332 E NAPIER AVE
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-7336
Mailing Address - Country:US
Mailing Address - Phone:269-308-2925
Mailing Address - Fax:
Practice Address - Street 1:756 PIPESTONE ST # 2
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-4845
Practice Address - Country:US
Practice Address - Phone:269-926-8535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704258890363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty