Healthcare Provider Details

I. General information

NPI: 1124012042
Provider Name (Legal Business Name): JOEL AARON MICHELS F.N.P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10505 SE 17TH AVE SUITE 210
MILWAUKIE OR
97222-7475
US

IV. Provider business mailing address

10505 SE 17TH AVE
MILWAUKIE OR
97222-7475
US

V. Phone/Fax

Practice location:
  • Phone: 503-467-1271
  • Fax: 855-232-6902
Mailing address:
  • Phone: 503-467-1271
  • Fax: 855-232-6902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200850147NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: