Provider Demographics
NPI:1265251656
Name:MAKOWSKI, MIRNA
Entity type:Individual
Prefix:
First Name:MIRNA
Middle Name:
Last Name:MAKOWSKI
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 1:1305 S 700 W
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-5436
Mailing Address - Country:US
Mailing Address - Phone:435-239-6208
Mailing Address - Fax:
Practice Address - Street 1:1305 S 700 W
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-5436
Practice Address - Country:US
Practice Address - Phone:435-239-6208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management