Healthcare Provider Details

I. General information

NPI: 1053889907
Provider Name (Legal Business Name): ALEXA CHRISTINE MIKULSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AKRON GENERAL AVE
AKRON OH
44307-2432
US

IV. Provider business mailing address

700 WHISPER CREEK LN
LODI OH
44254-9653
US

V. Phone/Fax

Practice location:
  • Phone: 266-333-0344
  • Fax:
Mailing address:
  • Phone: 330-419-9508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.005764RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.005764RX
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.005764RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: