Healthcare Provider Details

I. General information

NPI: 1437414570
Provider Name (Legal Business Name): MICHAEL MIADZIELEC CNP, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2012
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 WEST ST
GENEVA OH
44041-9723
US

IV. Provider business mailing address

3556 LAUREL DR
PERRY OH
44081-9778
US

V. Phone/Fax

Practice location:
  • Phone: 440-368-2526
  • Fax: 440-361-3397
Mailing address:
  • Phone: 440-368-2526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0041337
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: