Individual
HANNAH MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
16770 SW EDY RD STE 102, SHERWOOD, OR 97140-9679
(503) 216-9600
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA214103
OR
363AM0700X
Medical Physician Assistant
4651
WI
Other
Enumeration date
04/22/2019
Last updated
04/20/2023
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