MEDICARE: MAKALA NEW PNP-PC

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
1	363LP0200X	Pediatric Nurse Practitioner	202631129	NC
2	163W00000X	Registered Nurse	327353	NC

General Provider Information

NPI Number	:	1548148943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKALA NEW PNP-PC

Provider Business Mailing Address
First Line	:	3727 SW DURHAM DR APT 207
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-3781
Country	:	US
Telephone Number	:	336-694-3155
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 HYANNIS DR
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-8327
Country	:	US
Telephone Number	:	919-249-4700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2025
Last Update Date	:	06/04/2026

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Directions to “ MAKALA NEW PNP-PC” Practice Location

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