Provider Demographics
NPI:1982308193
Name:SULLIVAN, MICHAELA PAIGE (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:PAIGE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:PAIGE
Other - Last Name:SULEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1708 BOISE AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4204
Mailing Address - Country:US
Mailing Address - Phone:970-667-3116
Mailing Address - Fax:970-669-0159
Practice Address - Street 1:1708 BOISE AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4204
Practice Address - Country:US
Practice Address - Phone:970-667-3116
Practice Address - Fax:970-669-0159
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant