Healthcare Provider Details

I. General information

NPI: 1528649878
Provider Name (Legal Business Name): CHRISTY MAKURAT-COON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 INTERNATIONAL DR
LISLE IL
60532-3637
US

IV. Provider business mailing address

14 COUNTY ROAD 650
WALNUT MS
38683-8329
US

V. Phone/Fax

Practice location:
  • Phone: 331-332-4937
  • Fax:
Mailing address:
  • Phone: 302-629-6875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number904532
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number209026185
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209026185
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: