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General NPI Number Information
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NPI Number | 1912155185
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Entity Type | Individual
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Provider Name | SUSAN KAY MIKESKA NP
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Gender | Female
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Dates
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Enumeration Date | 08/30/2008
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Last Update Date | 08/30/2008
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Provider Practice Location Address
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Address Line | 238 W 10TH ST
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City | DALLAS
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State | TX
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Zip | 75208-4523
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Country | US
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Telephone | 214-942-2737
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Fax |
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Provider Business Mailing Address
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Address Line | 15562 BROOKHOLLOW CIR
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City | FORNEY
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State | TX
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Zip | 75126-5200
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Country | US
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Telephone | 972-564-1418
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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 | 08512
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License Number State | TX
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