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NPI Code Detail

MEDICARE: DR. ELIZABETH ANN MICKS MD, MPH

MEDICARE: DR. ELIZABETH ANN MICKS MD, MPH
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
1207V00000XObstetrics & Gynecology PhysicianMD60150794WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10293831OTHERL&I
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144405119
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIZABETH ANN MICKS MD, MPH
Provider Business Mailing Address
First Line : 3770 JANES RD
Second Line :
City : ARCATA
State : CA
Zip : 95521-4744
Country : US
Telephone Number : 707-825-7588
Fax Number : 707-825-8203
Provider Business Practice Location Address
First Line : 3770 JANES RD
Second Line :
City : ARCATA
State : CA
Zip : 95521-4744
Country : US
Telephone Number : 707-825-7588
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2008
Last Update Date : 12/15/2022

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