Healthcare Provider Details

I. General information

NPI: 1790434827
Provider Name (Legal Business Name): MIKELA NYLANDER-FRENCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22659 PACIFIC HWY S STE 201
DES MOINES WA
98198-5155
US

IV. Provider business mailing address

544 4TH AVE STE 102
FAIRBANKS AK
99701-4714
US

V. Phone/Fax

Practice location:
  • Phone: 206-824-3668
  • Fax:
Mailing address:
  • Phone: 907-456-5990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP017740T
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number191551
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP20893
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: