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NPI Code Detail

MEDICARE: JUDI MICKENHEIM RN

MEDICARE: JUDI MICKENHEIM RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse034729LA

General Provider Information

NPI Number : 1992711055
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDI MICKENHEIM RN
Provider Business Mailing Address
First Line : 2106 AVENUE F
Second Line :
City : BOGALUSA
State : LA
Zip : 70427-5027
Country : US
Telephone Number : 985-732-6655
Fax Number : 985-732-6678
Provider Business Practice Location Address
First Line : 2106 AVENUE F
Second Line :
City : BOGALUSA
State : LA
Zip : 70427-5027
Country : US
Telephone Number : 985-732-6655
Fax Number : 985-732-6678
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 07/08/2007

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