Basic Information
| Provider Information | |||||||||
| NPI: | 1659988830 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALTMAN | ||||||||
| FirstName: | MIKAYLA | ||||||||
| MiddleName: | CHEYENNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 244 BRANCHWOOD CIR | ||||||||
| Address2: | |||||||||
| City: | KINGS MOUNTAIN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280867787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042152351 | ||||||||
| FaxNumber: | 7042152351 | ||||||||
| Practice Location | |||||||||
| Address1: | 2675 COURT DR | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280541478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048244999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2020 | ||||||||
| LastUpdateDate: | 09/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | 34182511 | NC | Y |
No ID Information.