MEDICARE: DOROTHY R MIKEL NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	618628	TX

General Provider Information

NPI Number	:	1164687117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOROTHY R MIKEL NP

Provider Business Mailing Address
First Line	:	2301 LAUREL ST
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2265
Country	:	US
Telephone Number	:	281-935-1384
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 LAUREL ST
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2265
Country	:	US
Telephone Number	:	281-935-1384
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2008
Last Update Date	:	04/04/2012

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