Provider Demographics
NPI:1215788526
Name:ANDERSEN, MAKAYLA (ND, CNS)
Entity type:Individual
Prefix:DR
First Name:MAKAYLA
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:ND, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13931 MEAD CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:MI
Mailing Address - Zip Code:48808-8704
Mailing Address - Country:US
Mailing Address - Phone:517-667-9986
Mailing Address - Fax:
Practice Address - Street 1:6500 CENTURION DR STE 270
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8240
Practice Address - Country:US
Practice Address - Phone:616-315-1435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MENP813175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath