Individual
MICHAELA CHARLOTTE BAILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3917 WEST RD STE A, LOS ALAMOS, NM 87544-2292
(505) 661-8900
(505) 661-8916
Mailing address
3917 WEST RD STE A, LOS ALAMOS, NM 87544-2292
(505) 661-8900
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA2022-0098
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA2022-0098
NEW MEXICO MEDICAL BOARD LICENSE
NM
Enumeration date
06/10/2022
Last updated
02/19/2024
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