Healthcare Provider Details

I. General information

NPI: 1629123419
Provider Name (Legal Business Name): MAGGI JO MICHELS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S CEDAR ST STE 205
TACOMA WA
98405-2308
US

IV. Provider business mailing address

1901 S CEDAR ST STE 205
TACOMA WA
98405-2308
US

V. Phone/Fax

Practice location:
  • Phone: 253-301-6980
  • Fax: 253-272-7203
Mailing address:
  • Phone: 253-301-6980
  • Fax: 253-272-7203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN00058893
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30004844
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: