Tracy D. Mickelsen, CSFA
Surgical PA · Meridian, ID
UnclaimedCSFANPI 1801073655
- Primary taxonomy
- 363AS0400X
- Enumerated
- 2008-01-23
- Practice location
- Meridian, ID
- Last NPPES update
- 2017-12-07
State licenses
- ID · Physician assistant · NPPES self-reportedListed on NPI record
“Listed on NPI record” means the provider reported this license to NPPES; other statuses come from the state board’s public records as of the last import. License numbers are not shown.
Source: CMS National Plan & Provider Enumeration System (NPPES) and state licensing boards. ScrubHub shows name, credential, taxonomy, practice city/state and license status only.