Provider Demographics
NPI:1700190030
Name:CALDWELL, MISHA RAE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MISHA
Middle Name:RAE
Last Name:CALDWELL
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 1:2158 EXCHANGE ST.
Mailing Address - Street 2:SUITE #206/207
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103
Mailing Address - Country:US
Mailing Address - Phone:503-325-7337
Mailing Address - Fax:503-325-3706
Practice Address - Street 1:2158 EXCHANGE ST.
Practice Address - Street 2:SUITE #206/207
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103
Practice Address - Country:US
Practice Address - Phone:503-325-7337
Practice Address - Fax:503-325-3706
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9191206363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1700190030Medicaid