Provider Demographics
NPI:1578284709
Name:ALTHAUS, MICHAELA ANN
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:ANN
Last Name:ALTHAUS
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 1:12386 69TH LN NE
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-5051
Mailing Address - Country:US
Mailing Address - Phone:320-293-2384
Mailing Address - Fax:
Practice Address - Street 1:12386 69TH LN NE
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-5051
Practice Address - Country:US
Practice Address - Phone:320-293-2384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant