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General NPI Number Information
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NPI Number | 1942813712
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Entity Type | Individual
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Provider Name | MAKULA BROWN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 17330 NORTHLAND PARK CT STE 100
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4319
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Country | US
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Telephone | 313-707-1268
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Fax |
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Provider Business Mailing Address
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Address Line | 1257 WAYBURN ST
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City | GROSSE POINTE PARK
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State | MI
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Zip | 48230-1058
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Country | US
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Telephone | 313-707-1268
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704306338
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License Number State | MI
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