Provider Demographics
NPI:1447204995
Name:MIKLES, ERIKA M (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:M
Last Name:MIKLES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:M
Other - Last Name:JUERGENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:122 W 7TH AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2349
Mailing Address - Country:US
Mailing Address - Phone:509-838-7711
Mailing Address - Fax:509-747-4664
Practice Address - Street 1:1090 W PARK PL
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2785
Practice Address - Country:US
Practice Address - Phone:208-215-2005
Practice Address - Fax:844-807-3782
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-586363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807347700Medicaid
ID1667453Medicare ID - Type Unspecified
ID807347700Medicaid