Healthcare Provider Details

I. General information

NPI: 1619681913
Provider Name (Legal Business Name): MRS. EMILY ANN MIKSZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 BELMONT AVE
YOUNGSTOWN OH
44504-1106
US

IV. Provider business mailing address

3457 HARLANSBURG RD
NEW CASTLE PA
16101-8341
US

V. Phone/Fax

Practice location:
  • Phone: 330-740-9200
  • Fax:
Mailing address:
  • Phone: 724-614-5369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number300151
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: