Provider Demographics
NPI:1255146163
Name:MAKO, PAMELA
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:MAKO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 W SHARON ST
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:NE
Mailing Address - Zip Code:68730-3251
Mailing Address - Country:US
Mailing Address - Phone:719-688-3188
Mailing Address - Fax:
Practice Address - Street 1:710 W SHARON ST
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:NE
Practice Address - Zip Code:68730-3251
Practice Address - Country:US
Practice Address - Phone:719-688-3188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-08
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion