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NPI Code Detail

MEDICARE: CAROL J MAKER PLMHP

MEDICARE: CAROL J MAKER PLMHP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor7498NE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073701629
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROL J MAKER PLMHP
Provider Business Mailing Address
First Line : 625 E 39TH ST
Second Line :
City : SOUTH SIOUX CITY
State : NE
Zip : 68776-3445
Country : US
Telephone Number : 402-494-0040
Fax Number : 402-494-0050
Provider Business Practice Location Address
First Line : 625 E 39TH ST
Second Line :
City : SOUTH SIOUX CITY
State : NE
Zip : 68776-3445
Country : US
Telephone Number : 402-494-0040
Fax Number : 402-494-0050
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2007
Last Update Date : 10/09/2007

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Directions to “ CAROL J MAKER PLMHP” Practice Location

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