Provider Demographics
NPI:1497453096
Name:NAMEY, MIKAELA (PA-C)
Entity Type:Individual
Prefix:
First Name:MIKAELA
Middle Name:
Last Name:NAMEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MIKAELA
Other - Middle Name:
Other - Last Name:GIULIANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 KENT DR
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1926
Mailing Address - Country:US
Mailing Address - Phone:215-350-3919
Mailing Address - Fax:
Practice Address - Street 1:625 W RIDGE PIKE STE 300
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1180
Practice Address - Country:US
Practice Address - Phone:610-825-1994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA064319363A00000X
PAOA006374363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA064319OtherMEDICAL PHYSICIAN ASSISTANT
PAOA006374OtherOSTEOPATHIC PHYSICIAN ASSISTANT