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General NPI Number Information
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NPI Number | 1245649615
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Entity Type | Individual
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Provider Name | JODI MICSKY CNP
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Gender | Female
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Dates
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Enumeration Date | 08/10/2014
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 715 E WESTERN RESERVE RD
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City | POLAND
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State | OH
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Zip | 44514-3358
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Country | US
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Telephone | 330-726-3204
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Fax | 330-729-9316
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Provider Business Mailing Address
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Address Line | PO BOX 636988
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City | CINCINNATI
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State | OH
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Zip | 45263-6988
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Country | US
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Telephone | 888-940-2722
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Fax | 513-632-8898
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APRN.CNP.16119
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APRN.CNP.16119
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License Number State | OH
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