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General NPI Number Information
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NPI Number | 1447800388
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Entity Type | Individual
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Provider Name | ISABEL NICOLE MIKE
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Gender | Female
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Dates
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Enumeration Date | 09/12/2019
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 9150 W INDIAN SCHOOL RD STE 131
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City | PHOENIX
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State | AZ
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Zip | 85037-2388
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Country | US
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Telephone | 623-873-0112
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Fax |
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Provider Business Mailing Address
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Address Line | 2030 E BROADWAY RD APT 1033
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City | TEMPE
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State | AZ
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Zip | 85282-1791
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Country | US
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Telephone | 480-612-3892
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 8837
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License Number State | AZ
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