Healthcare Provider Details

I. General information

NPI: 1770453532
Provider Name (Legal Business Name): MICHAELA JUAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHAELA CUNNINGHAM

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N LORRAINE ST STE 202
HUTCHINSON KS
67501-5600
US

IV. Provider business mailing address

1600 N LORRAINE ST STE 202
HUTCHINSON KS
67501-5600
US

V. Phone/Fax

Practice location:
  • Phone: 620-663-7595
  • Fax: 620-888-6302
Mailing address:
  • Phone: 620-663-7595
  • Fax: 620-888-6302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: