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General NPI Number Information
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NPI Number | 1366575177
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Entity Type | Individual
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Provider Name | NADA MICKELSON NP
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Gender | Female
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3259 N WINDSONG DR
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-1227
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Country | US
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Telephone | 928-772-6422
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Fax | 928-772-6425
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Provider Business Mailing Address
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Address Line | 8680 N OAK FOREST DR
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City | PRESCOTT
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State | AZ
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Zip | 86305-8702
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Country | US
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Telephone | 928-445-4404
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Fax | 928-445-4404
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APO225
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License Number State | AZ
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