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NPI Code Detail

MEDICARE: GAIL MIKUCKI FNP

MEDICARE: GAIL MIKUCKI FNP
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
1363LF0000XFamily Nurse Practitioner209009294IL

General Provider Information

NPI Number : 1225301575
Entity Type Code : Individual
Provider Name (Legal Business Name) : GAIL MIKUCKI FNP
Provider Business Mailing Address
First Line : 800 BIESTERFIELD RD
Second Line :
City : ELK GROVE VLG
State : IL
Zip : 60007-3361
Country : US
Telephone Number : 440-887-4718
Fax Number : 440-842-8835
Provider Business Practice Location Address
First Line : 800 BIESTERFIELD RD
Second Line :
City : ELK GROVE VLG
State : IL
Zip : 60007-3361
Country : US
Telephone Number : 440-887-4718
Fax Number : 440-842-8835
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2012
Last Update Date : 02/17/2012

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