=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235624271
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAKILAH RAE FURLAN FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2018
-----------------------------------------------------
Last Update Date | 09/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6006 ANDREWS RD
-----------------------------------------------------
City | MENTOR ON THE LAKE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44060-2822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-386-9130
-----------------------------------------------------
Fax | 440-386-9131
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1430 OAK CT STE 100
-----------------------------------------------------
City | BEAVERCREEK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45430-1064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-404-1101
-----------------------------------------------------
Fax | 937-404-1210
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 451968
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP0035051
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------