Provider Demographics
NPI:1851154256
Name:MCMAKIN, MIKEL (PA-C)
Entity type:Individual
Prefix:
First Name:MIKEL
Middle Name:
Last Name:MCMAKIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 LONGVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-3614
Mailing Address - Country:US
Mailing Address - Phone:206-992-2151
Mailing Address - Fax:
Practice Address - Street 1:21137 SR 410 E STE I
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-8775
Practice Address - Country:US
Practice Address - Phone:253-862-5275
Practice Address - Fax:855-673-1403
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61523671363A00000X
ORPA219565363A00000X, 363AM0700X
WA1218544363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical