Provider Demographics
NPI:1457008815
Name:MICHALAK, BLAIR NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:NICOLE
Last Name:MICHALAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BLAIR
Other - Middle Name:NICOLE
Other - Last Name:BOKELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1805 SHEA CENTER DR STE 450
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2255
Mailing Address - Country:US
Mailing Address - Phone:303-357-2559
Mailing Address - Fax:720-828-7901
Practice Address - Street 1:9135 RIDGELINE BLVD STE 190
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2395
Practice Address - Country:US
Practice Address - Phone:720-828-7755
Practice Address - Fax:720-828-7901
Is Sole Proprietor?:No
Enumeration Date:2022-03-06
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant