MRS. MICHELLE CERTIK (NPI# 1124512207) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124512207 |
| Entity Type | Individual |
| Full Name | MRS. MICHELLE CERTIK |
| Credential | PA-C |
| Practice Address |
3917 West Rd Ste A Los Alamos NM 87544-2292 |
| Practice Telephone | 5056618900 |
| Practice Fax Number | 5056618916 |
| Mailing Telephone | 5056618900 |
| Mailing Fax Number | 5056618916 |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2018-06-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA2018-0034 | NM | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3917 WEST RD STE A |
| City | LOS ALAMOS |
| State | NM |
| Zip Code | 87544-2292 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528073384 | Heather Ellen Marancenbaum | Family Medicine | 3917 West Rd Ste A, Los Alamos, NM 87544-2292 | 2006-07-30 |
| 1588217749 | Pema L Tamang | Family Medicine | 3917 West Rd Ste A, Los Alamos, NM 87544-2292 | 2019-07-17 |
| 1619449766 | Jordan A Lichthardt | Dietitian, Registered | 3917 West Rd Ste A, Los Alamos, NM 87544-2292 | 2018-12-28 |
| 1760964506 | Leigh Barham | Family Medicine | 3917 West Rd Ste A, Los Alamos, NM 87544 | 2018-08-29 |
| 1457881625 | Sara E Mcevers | Nurse Practitioner | 3917 West Rd Ste A, Los Alamos, NM 87544-2292 | 2017-06-19 |
| 1750720306 | Elena Soliz Mcatee | Family Medicine | 3917 West Rd Ste A, Los Alamos, NM 87544-2292 | 2013-06-17 |
| 1487962031 | Linda Taylor | Physician Assistant | 3917 West Rd Ste A, Los Alamos, NM 87544-2292 | 2010-09-16 |
| 1811025703 | Theresa Ann Bubenzer | Registered Nurse | 3917 West Rd Ste A, Los Alamos, NM 87544-2292 | 2007-03-01 |
| 1861540437 | Ann K Ferris | Internal Medicine | 3917 West Rd Ste A, Los Alamos, NM 87544-2275 | 2007-01-08 |
| 1740337146 | Mara Trainer | Nurse Practitioner | 3917 West Rd Ste A, Los Alamos, NM 87544-2292 | 2007-01-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679945935 | Zia Home Health | Home Health | 1475 Central Ave., Suite 125, Los Alamos, NM 87544 | 2015-10-27 |
| 1295131167 | Sara Pocernik | Dietitian, Registered | 1450 Iris Street, Los Alamos, NM 87544 | 2014-11-05 |
| 1760824890 | Lisa Renee Marr Lyon | Psychologist | 3917 West Road, Suite 128, Children's Clinic, P.a., Los Alamos, NM 87544 | 2013-07-17 |
| 1558629725 | Rachel Meyer | Dentist | 112 Central Park Square, Los Alamos, NM 87544 | 2012-04-25 |
| 1902183908 | Susana T. Chavarria | Occupational Therapist | 5 Quemazon Pl., Los Alamos, NM 87544 | 2011-11-04 |
| 1881998664 | Dr. Tom Child and Adolescent Medicine | Pediatrics | Los Alamos Medical Center, 3917 West Rd, Suite M250, Los Alamos, NM 87544 | 2011-01-07 |
| 1952565905 | Dawn Judy Barr | Social Worker | 3 Agila Ct, Los Alamos, NM 87544 | 2008-07-17 |
| 1649452129 | Ellen Vandergust Ballard | Dentist | 111 Longview, Suite B-3, White Rock, NM 87544 | 2007-11-27 |
| 1629290283 | Wildwind Dental | Dentist | 111 Longview Drive, Suite B3, Los Alamos, NM 87544 | 2007-05-03 |
| 1255407342 | Sarah Sue Teasdale | Counselor | 1362 C Trinity Dr, Los Alamos, NM 87544 | 2006-11-28 |
| Find all providers in zip 87544 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265551469 | Mary Loring Daggett | Physician Assistant | Bikini Atoll Road Ms D421, Los Alamos, NM 87545 | 2007-03-28 |
| 1487962031 | Linda Taylor | Physician Assistant | 3917 West Rd Ste A, Los Alamos, NM 87544-2292 | 2010-09-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386284602 | Christopher Whorley | Physician Assistant | 4683 Idlewilde Ln Se, Albuquerque, NM 87108-3421 | 2020-01-15 |
| 1053836809 | Alysha Gallegos | Physician Assistant | 6112 Molinero Ct Sw, Albuquerque, NM 87105-6814 | 2017-08-13 |
| 1164978540 | Deborah L Thorne | Physician Assistant | 111 W Lucero Ave Ste 6, Las Cruces, NM 88005-1829 | 2016-08-26 |
| 1134572738 | Weston Bradley Graff | Physician Assistant | 703 Christopher Dr, Belen, NM 87002-2617 | 2016-07-19 |
| 1295194629 | Ryan Grange | Physician Assistant | 1851 Old Highway 66 Unit 1, Edgewood, NM 87015 | 2016-02-12 |
| 1720445562 | Rebecca Gahan Brown | Physician Assistant | 150 N Roadrunner Pkwy, Las Cruces, NM 88011 | 2016-01-25 |
| 1508232240 | Edward R Watson | Physician Assistant | 2530 S Telshor Blvd Ste 207, Las Cruces, NM 88011-4975 | 2015-08-17 |
| 1306225180 | Allison Rose Crossey | Physician Assistant | 201 Cedar Street Se, Suite 6600, Albuquerque, NM 87106 | 2015-05-26 |
| 1528452208 | Taylor Bottari | Physician Assistant | 208 W Dl Ingram, Cannon Afb, NM 88103 | 2015-03-20 |
| 1336543115 | Pamela O Black Md, P.a., Dba Quadra Health Institute | Physician Assistant | 3820 Commons Ave Ne # M, Albuquerque, NM 87109-5831 | 2014-10-22 |
| Find all providers with the same taxonomy | ||||
| City | LOS ALAMOS |
| Zip Code | 87544 |
Please comment or provide details below to improve the information on MRS. MICHELLE CERTIK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.