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Individual

MIKENZIE MARIE MIKKELSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1635 CAREGIVER CIR, RAPID CITY, SD 57702-8529
(605) 755-6700
Mailing address
1635 CAREGIVER CIR, RAPID CITY, SD 57702-8529
(605) 755-6700

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary

Other

Enumeration date
02/24/2023
Last updated
02/24/2023
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