Healthcare Provider Details

I. General information

NPI: 1558244871
Provider Name (Legal Business Name): MAKAYLA FIKRAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2025
Last Update Date: 07/26/2025
Certification Date: 07/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 INDUSTRIAL AVE
WILLISTON VT
05495-4448
US

IV. Provider business mailing address

4501 LAKEWOOD ST
PLEASANTON CA
94588-4340
US

V. Phone/Fax

Practice location:
  • Phone: 802-878-1008
  • Fax:
Mailing address:
  • Phone: 925-520-5593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95035598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: