Provider Demographics
NPI:1598330532
Name:FAUKE, MIKA
Entity Type:Individual
Prefix:
First Name:MIKA
Middle Name:
Last Name:FAUKE
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 1:12270 SW CENTER ST APT 102
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1760
Mailing Address - Country:US
Mailing Address - Phone:779-239-8218
Mailing Address - Fax:
Practice Address - Street 1:12270 SW CENTER ST APT 102
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1760
Practice Address - Country:US
Practice Address - Phone:779-239-8218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other