Provider Demographics
NPI:1891889879
Name:EMOND, MICHAEL (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:EMOND
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 3RD AVENUE WEST
Mailing Address - Street 2:DRAWER H
Mailing Address - City:RICHARDTON
Mailing Address - State:ND
Mailing Address - Zip Code:58652
Mailing Address - Country:US
Mailing Address - Phone:701-974-3304
Mailing Address - Fax:701-974-3307
Practice Address - Street 1:212 3RD AVENUE WEST
Practice Address - Street 2:
Practice Address - City:RICHARDTON
Practice Address - State:ND
Practice Address - Zip Code:58652
Practice Address - Country:US
Practice Address - Phone:701-974-3304
Practice Address - Fax:701-974-3307
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND0024363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDR02145Medicare UPIN