MEDICARE: MISS ROSETTE SANDRINE MAKON AGNP-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	363LG0600X	Gerontology Nurse Practitioner	AG08170019	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	811435	NV
3	363LG0600X	Gerontology Nurse Practitioner	811435	NV

General Provider Information

NPI Number	:	1700302445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ROSETTE SANDRINE MAKON AGNP-C

Provider Business Mailing Address
First Line	:	102 WOODMONT BLVD STE 600
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-5250
Country	:	US
Telephone Number	:	888-987-1151
Fax Number	:

Provider Business Practice Location Address
First Line	:	3830 E FLAMINGO RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-6234
Country	:	US
Telephone Number	:	725-269-1044
Fax Number	:	725-712-8163

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

Provider Enumeration Date	:	08/15/2017
Last Update Date	:	10/23/2025

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