Provider Demographics
NPI:1811176282
Name:CATHY J MICHAELIS
Entity type:Organization
Organization Name:CATHY J MICHAELIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MICHAELIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-477-8375
Mailing Address - Street 1:10750 CEDAR WAY
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-4833
Mailing Address - Country:US
Mailing Address - Phone:530-477-8375
Mailing Address - Fax:530-477-8375
Practice Address - Street 1:10750 CEDAR WAY
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-4833
Practice Address - Country:US
Practice Address - Phone:530-477-8375
Practice Address - Fax:530-477-8375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty