Provider Demographics
NPI:1336638873
Name:PEKALA, MIKAYLA ASHLEY
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:ASHLEY
Last Name:PEKALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-4600
Mailing Address - Country:US
Mailing Address - Phone:810-535-5587
Mailing Address - Fax:
Practice Address - Street 1:110 N SAGINAW ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-4600
Practice Address - Country:US
Practice Address - Phone:810-535-5587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI$$$$$$$$$Medicaid