Healthcare Provider Details

I. General information

NPI: 1548148943
Provider Name (Legal Business Name): MAKALA NEW PNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 HYANNIS DR
HOLLY SPRINGS NC
27540-8327
US

IV. Provider business mailing address

3727 SW DURHAM DR APT 207
DURHAM NC
27707-3781
US

V. Phone/Fax

Practice location:
  • Phone: 919-249-4700
  • Fax:
Mailing address:
  • Phone: 336-694-3155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number202631129
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number327353
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: