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General NPI Number Information
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NPI Number | 1295152015
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Entity Type | Individual
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Provider Name | LISA MAKARA N.P.
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Gender | Female
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Dates
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Enumeration Date | 03/19/2014
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1485 M 139
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City | BENTON HARBOR
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State | MI
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Zip | 49022-5711
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Country | US
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Telephone | 269-934-1611
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Fax | 269-927-1326
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Provider Business Mailing Address
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Address Line | 1485 M 139
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City | BENTON HARBOR
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State | MI
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Zip | 49022-5711
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Country | US
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Telephone | 269-934-1611
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Fax | 269-927-1326
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704305988
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License Number State | MI
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