MEDICARE: EDNAH KWAMBOKA MAKORI NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4704258890	MI

General Provider Information

NPI Number	:	1013687946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDNAH KWAMBOKA MAKORI NP

Provider Business Mailing Address
First Line	:	332 E NAPIER AVE
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-7336
Country	:	US
Telephone Number	:	269-308-2925
Fax Number	:

Provider Business Practice Location Address
First Line	:	756 PIPESTONE ST # 2
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-4845
Country	:	US
Telephone Number	:	269-926-8535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2021
Last Update Date	:	09/13/2021

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