MEDICARE: LAUREEN MUSHATI-MAKOKO NP-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	363L00000X	Nurse Practitioner	1-109952	AL

General Provider Information

NPI Number	:	1518377282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREEN MUSHATI-MAKOKO NP-C

Provider Business Mailing Address
First Line	:	5933 LAKE CYRUS DR
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-4163
Country	:	US
Telephone Number	:	256-457-6397
Fax Number	:

Provider Business Practice Location Address
First Line	:	5933 LAKE CYRUS DR
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-4163
Country	:	US
Telephone Number	:	256-457-6397
Fax Number	:

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

Provider Enumeration Date	:	05/05/2014
Last Update Date	:	05/05/2014

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