Individual
ERIN LEAH MICKELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1542 MARVIN GARDENS LN, PRESCOTT, AZ 86301-5528
(928) 312-2011
Mailing address
10 BROADMOOR, PRESCOTT, AZ 86305-5086
(928) 445-2692
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
137284
AZ
Other
Enumeration date
12/28/2018
Last updated
12/28/2018
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