Healthcare Provider Details

I. General information

NPI: 1992902480
Provider Name (Legal Business Name): RENEE MAKOWSKI SERRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENEE LYNN MAKOWSKI MD

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
TACOMA WA
98431
US

IV. Provider business mailing address

MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
TACOMA WA
98431
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-3885
  • Fax:
Mailing address:
  • Phone: 253-968-3885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25054
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: