Healthcare Provider Details

I. General information

NPI: 1346172699
Provider Name (Legal Business Name): MAKAYLA GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 MILAN AVE
NORWALK OH
44857-1131
US

IV. Provider business mailing address

41 MILAN AVE
MONROEVILLE OH
44847-9434
US

V. Phone/Fax

Practice location:
  • Phone: 419-602-4083
  • Fax:
Mailing address:
  • Phone: 419-602-4083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: