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General NPI Number Information
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NPI Number | 1851911655
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Entity Type | Individual
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Provider Name | VINCENT MIKULA NP
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Gender | Male
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Dates
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Enumeration Date | 04/21/2020
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Last Update Date | 04/21/2020
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Provider Practice Location Address
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Address Line | 1615 N RIVER RD NE
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City | WARREN
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State | OH
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Zip | 44483-2437
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Country | US
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Telephone | 330-372-2333
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Fax |
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Provider Business Mailing Address
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Address Line | 1615 N RIVER RD NE
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City | WARREN
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State | OH
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Zip | 44483-2437
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Country | US
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Telephone |
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CMP.026652
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License Number State | OH
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