Provider Demographics
NPI:1720769433
Name:MAKULA, NICOLE ALECIA (RN, BSN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALECIA
Last Name:MAKULA
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ALECIA
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:1617 S TYLER ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1143
Mailing Address - Country:US
Mailing Address - Phone:360-790-3601
Mailing Address - Fax:
Practice Address - Street 1:1617 S TYLER ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1143
Practice Address - Country:US
Practice Address - Phone:360-790-3601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60062923163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse