Provider Demographics
NPI:1497543615
Name:RICH, MAKENNA JO
Entity type:Individual
Prefix:
First Name:MAKENNA
Middle Name:JO
Last Name:RICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SO SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776
Mailing Address - Country:US
Mailing Address - Phone:402-494-1136
Mailing Address - Fax:402-494-1239
Practice Address - Street 1:3425 DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:SO SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776
Practice Address - Country:US
Practice Address - Phone:402-494-1136
Practice Address - Fax:402-494-1239
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant