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NPI Code Detail

MEDICARE: NICOLE ANN MAKI ATC

MEDICARE: NICOLE ANN MAKI ATC
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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1962841288
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE ANN MAKI ATC
Provider Business Mailing Address
First Line : N11498 MUSKELLUNGE LAKE RD
Second Line :
City : TOMAHAWK
State : WI
Zip : 54487-9707
Country : US
Telephone Number : 715-493-0392
Fax Number :
Provider Business Practice Location Address
First Line : 1401 PRESQUE ISLE AVE
Second Line :
City : MARQUETTE
State : MI
Zip : 49855-2818
Country : US
Telephone Number : 906-227-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2013
Last Update Date : 06/19/2013

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