Provider Demographics
NPI:1629123419
Name:MICHELS, MAGGI JO (ARNP)
Entity Type:Individual
Prefix:
First Name:MAGGI
Middle Name:JO
Last Name:MICHELS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S CEDAR ST
Mailing Address - Street 2:STE 205
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2308
Mailing Address - Country:US
Mailing Address - Phone:253-301-6980
Mailing Address - Fax:253-272-7203
Practice Address - Street 1:1901 S CEDAR ST
Practice Address - Street 2:STE 205
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2308
Practice Address - Country:US
Practice Address - Phone:253-301-6980
Practice Address - Fax:253-272-7203
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00058893163WG0000X
WAAP30004844363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAS64527Medicare UPIN
WAG8857735Medicare PIN