Healthcare Provider Details

I. General information

NPI: 1235624271
Provider Name (Legal Business Name): MAKILAH RAE FURLAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS MAKILAH WITT

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6006 ANDREWS RD
MENTOR ON THE LAKE OH
44060-2822
US

IV. Provider business mailing address

1430 OAK CT STE 100
BEAVERCREEK OH
45430-1064
US

V. Phone/Fax

Practice location:
  • Phone: 440-386-9130
  • Fax: 440-386-9131
Mailing address:
  • Phone: 937-404-1101
  • Fax: 937-404-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number451968
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP0035051
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: