Provider Demographics
NPI:1013733708
Name:ROBERTSON, MAKENNA (FSID)
Entity type:Individual
Prefix:
First Name:MAKENNA
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:FSID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2539 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49457-9235
Mailing Address - Country:US
Mailing Address - Phone:231-343-9678
Mailing Address - Fax:
Practice Address - Street 1:2339 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:TWIN LAKE
Practice Address - State:MI
Practice Address - Zip Code:49457
Practice Address - Country:US
Practice Address - Phone:231-343-9678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula