Provider Demographics
NPI:1770897936
Name:MIKHAYLISHIN, ANNA M (PA)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:M
Last Name:MIKHAYLISHIN
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 1:729 SUNRISE AVE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4565
Mailing Address - Country:US
Mailing Address - Phone:916-782-1717
Mailing Address - Fax:916-782-5270
Practice Address - Street 1:729 SUNRISE AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4565
Practice Address - Country:US
Practice Address - Phone:916-782-1717
Practice Address - Fax:916-782-5270
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21051363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical