Provider Demographics
NPI:1700302445
Name:MAKON, ROSETTE SANDRINE (AGNP-C)
Entity Type:Individual
Prefix:MISS
First Name:ROSETTE
Middle Name:SANDRINE
Last Name:MAKON
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-6231
Mailing Address - Country:US
Mailing Address - Phone:469-989-2697
Mailing Address - Fax:
Practice Address - Street 1:1000 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-6231
Practice Address - Country:US
Practice Address - Phone:702-479-4881
Practice Address - Fax:800-861-7750
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAG08170019363LG0600X
NV811435363LP0808X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health