1548446776 NPI number — DR. JUDITH ANN MICKELSON AUD

Table of content: DR. JUDITH ANN MICKELSON AUD (NPI 1548446776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548446776 NPI number — DR. JUDITH ANN MICKELSON AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICKELSON
Provider First Name:
JUDITH
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WAISER
Provider Other First Name:
JUDITH
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548446776
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13949 W MEEKER BLVD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
SUN CITY WEST
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85375-4436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-975-1660
Provider Business Mailing Address Fax Number:
623-975-1654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13949 W MEEKER BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SUN CITY WEST
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85375-4436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-975-1660
Provider Business Practice Location Address Fax Number:
623-975-1654
Provider Enumeration Date:
01/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  DA4649 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DA4649 . This is a "DEPARTMENT OF HEALTH SERVICES" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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