1235624271 NPI number — MRS. MAKILAH RAE FURLAN FNP-C

Table of content: DR. HOLLY KYLE KRUEGER PH.D. (NPI 1881672293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235624271 NPI number — MRS. MAKILAH RAE FURLAN FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FURLAN
Provider First Name:
MAKILAH
Provider Middle Name:
RAE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WITT
Provider Other First Name:
MAKILAH
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235624271
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
880 MULL AVE
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44313-7522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-864-8898
Provider Business Mailing Address Fax Number:
330-864-8865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
880 MULL AVE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44313-7522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-864-8898
Provider Business Practice Location Address Fax Number:
330-864-8865
Provider Enumeration Date:
06/22/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  451968 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: APRN.CNP0035051 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)