Healthcare Provider Details

I. General information

NPI: 1891950549
Provider Name (Legal Business Name): JAMES MIKCO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY DRIVE
PITTSBURGH PA
15240
US

IV. Provider business mailing address

116 W SHAW PL
GLENSHAW PA
15116-1726
US

V. Phone/Fax

Practice location:
  • Phone: 412-688-6235
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN568296
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: