Basic Information
| Provider Information | |||||||||
| NPI: | 1952031437 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIKA | ||||||||
| FirstName: | HANNAH | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 936857 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 311936857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106629300 | ||||||||
| FaxNumber: | 9106629301 | ||||||||
| Practice Location | |||||||||
| Address1: | 1725 NEW HANOVER MEDICAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284035345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106629300 | ||||||||
| FaxNumber: | 9106629301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2022 | ||||||||
| LastUpdateDate: | 11/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363A00000X | 0010-12562 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.