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Individual

AMANDA JEAN MAKI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.-C

Contact information

Practice address
80 SEYMOUR STREET, HARTFORD HOSPITAL SURGERY DEPT, HARTFORD, CT 06102-5037
(860) 545-2840
Mailing address
P.O. BOX 415933, HARTFORD HOSPITAL PROFESSIONAL SERVICES, BOSTON, MA 02241-5933
(860) 545-7602

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002498
CT
363AS0400X
Surgical Physician Assistant
PA3792
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003024981
CT
Enumeration date
07/16/2009
Last updated
02/04/2011
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