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NPI Profile for THERESA MICKNICK in CARBONDALE, PA.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Medical |
363AM0700X | 97 | Physician Assistant |
| NPI # | 1164774261 |
|
| Status | Active | |
| Credentials | PAC | |
| Entity | Individual | |
| Enumeration date | 10/12/2012 | |
| Last updated | 10/12/2012 - About 14 years ago | |
| Sole proprietor 1 | No | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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THERESA MICKNICK
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THERESA MICKNICK, PAC