Provider Demographics
NPI:1013439710
Name:AMROLIWALLA, MICHAELA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHAELA
Middle Name:
Last Name:AMROLIWALLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:
Other - Last Name:KATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 W 42ND ST STE 3100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-0612
Mailing Address - Country:US
Mailing Address - Phone:308-632-2872
Mailing Address - Fax:308-632-4191
Practice Address - Street 1:2 W 42ND ST STE 3100
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-0612
Practice Address - Country:US
Practice Address - Phone:308-632-2872
Practice Address - Fax:308-632-4191
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2171363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant