Healthcare Provider Details

I. General information

NPI: 1144405119
Provider Name (Legal Business Name): ELIZABETH ANN MICKS MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 10TH ST
ARCATA CA
95521-6210
US

IV. Provider business mailing address

770 10TH ST
ARCATA CA
95521-6210
US

V. Phone/Fax

Practice location:
  • Phone: 707-630-5177
  • Fax:
Mailing address:
  • Phone: 707-825-7588
  • Fax: 707-630-5177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA101359
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: