Individual
JACOB MICHELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2005 ARLINGTON AVE, CALDWELL, ID 83605-4808
(208) 459-1025
(208) 466-5359
Mailing address
PO BOX 9, NAMPA, ID 83653-0009
(208) 461-7149
(208) 467-3391
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
08/24/2020
Last updated
08/24/2020
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