Healthcare Provider Details

I. General information

NPI: 1215788526
Provider Name (Legal Business Name): MAKAYLA ANDERSEN ND, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 CENTURION DR STE 270
LANSING MI
48917-8240
US

IV. Provider business mailing address

13931 MEAD CREEK RD
BATH MI
48808-8704
US

V. Phone/Fax

Practice location:
  • Phone: 616-315-1435
  • Fax:
Mailing address:
  • Phone: 517-667-9986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNP813
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: