Individual
TAMARA MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11511 CANTERWOOD BLVD STE 105, GIG HARBOR, WA 98332-5813
(253) 985-2949
(253) 985-2948
Mailing address
11511 CANTERWOOD BLVD STE 105, GIG HARBOR, WA 98332-5813
(253) 985-2949
(253) 985-2948
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60490222
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2041829
—
WA
Enumeration date
08/08/2014
Last updated
12/18/2020
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