Provider Demographics
NPI:1457947483
Name:MAKORI-MALINDA, ABIGAEL OBONYO
Entity Type:Individual
Prefix:
First Name:ABIGAEL
Middle Name:OBONYO
Last Name:MAKORI-MALINDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ABIGAEL
Other - Middle Name:OBONYO
Other - Last Name:MAKORI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12974 S WIDMER ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-8814
Mailing Address - Country:US
Mailing Address - Phone:913-548-6129
Mailing Address - Fax:
Practice Address - Street 1:12974 S WIDMER ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-8814
Practice Address - Country:US
Practice Address - Phone:913-548-6129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-79809-072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily