MEDICARE: JENNIFER MAKUAKANE PA-C

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	363A00000X	Physician Assistant	369906-1206	UT

General Provider Information

NPI Number	:	1225693229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MAKUAKANE PA-C

Provider Business Mailing Address
First Line	:	11026 N 5730 W
Second Line	:
City	:	HIGHLAND
State	:	UT
Zip	:	84003-9425
Country	:	US
Telephone Number	:	385-202-3278
Fax Number	:

Provider Business Practice Location Address
First Line	:	1416 W STATE RD
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-5015
Country	:	US
Telephone Number	:	385-202-3278
Fax Number	:

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

Provider Enumeration Date	:	05/06/2019
Last Update Date	:	04/14/2026

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