Provider Demographics
NPI:1922563824
Name:HOUCHIN, MICHAELA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:ANN
Last Name:HOUCHIN
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:PO BOX 1725
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-1725
Mailing Address - Country:US
Mailing Address - Phone:308-398-6400
Mailing Address - Fax:308-398-6408
Practice Address - Street 1:3610 RICHMOND CIR STE 100
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3910
Practice Address - Country:US
Practice Address - Phone:308-398-6400
Practice Address - Fax:308-398-6408
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025178000Medicaid