Individual
MIKAYLA D EXLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
16901 LAKESIDE HILLS CT, OMAHA, NE 68130-2318
(402) 707-8111
Mailing address
1117 AVENUE K, CARTER LAKE, IA 51510-1390
(515) 422-1932
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
116611
IA
363A00000X
Physician Assistant
Primary
2826
NE
Other
Enumeration date
10/14/2022
Last updated
10/16/2024
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