Healthcare Provider Details

I. General information

NPI: 1750716213
Provider Name (Legal Business Name): ANGELA WAKEFIELD MICHALKA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 CAMPUS DR STE A
SCARBOROUGH ME
04074-7229
US

IV. Provider business mailing address

92 CAMPUS DR STE A
SCARBOROUGH ME
04074-7229
US

V. Phone/Fax

Practice location:
  • Phone: 207-885-0011
  • Fax: 207-885-5851
Mailing address:
  • Phone: 207-885-0011
  • Fax: 207-885-5851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1424
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1424
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: