Provider Demographics
NPI:1891918009
Name:WESTPHAL, MICHAELA L (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:L
Last Name:WESTPHAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 12TH AVE
Mailing Address - Street 2:BUILDING A
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-3100
Mailing Address - Country:US
Mailing Address - Phone:814-944-5062
Mailing Address - Fax:814-944-5557
Practice Address - Street 1:1701 12TH AVE
Practice Address - Street 2:BUILDING A
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-3100
Practice Address - Country:US
Practice Address - Phone:814-944-5062
Practice Address - Fax:814-944-5557
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052815363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant