Individual
JESSICA MICKELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
910 W 5TH AVE STE 501, SPOKANE, WA 99204-2967
(509) 755-5220
Mailing address
910 W 5TH AVE STE 501, SPOKANE, WA 99204-2967
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60971945
WA
Other
Enumeration date
08/28/2018
Last updated
09/02/2019
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