Provider Demographics
NPI:1467923300
Name:RAISKIN, MIKALA JAMES (ARNP)
Entity Type:Individual
Prefix:
First Name:MIKALA
Middle Name:JAMES
Last Name:RAISKIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MIKALA
Other - Middle Name:J
Other - Last Name:SAVAIDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8230 CARRLEIGH PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1726
Mailing Address - Country:US
Mailing Address - Phone:170-390-1259
Mailing Address - Fax:
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:703-901-2591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60913436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily