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General NPI Number Information
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NPI Number | 1851154256
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Entity Type | Individual
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Provider Name | MIKEL MCMAKIN PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/30/2024
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 21137 SR 410 E STE I
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City | BONNEY LAKE
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State | WA
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Zip | 98391-8775
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Country | US
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Telephone | 253-862-5275
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Fax | 855-673-1403
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Provider Business Mailing Address
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Address Line | 608 LONGVIEW AVE
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City | ANACORTES
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State | WA
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Zip | 98221-3614
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Country | US
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Telephone | 206-992-2151
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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 | PA61523671
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA219565
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1218544
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA219565
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License Number State | OR
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