Individual provider · Type 1 NPI
Theresa Micknick, PAC
Medical Physician Assistant · Carbondale, PA
NPI number
1164774261
Active
Practice location
165 Fallbrook St
Carbondale, PA 18433
Mailing address
217 Bell Mountain Rd
Jermyn, PA 18433-3611
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Medical Physician Assistant Primary | 363AM0700X | MA001651L (PA) |
Medical Physician Assistant: Definition to come...
Other medical physician assistant providers in Carbondale
About NPI 1164774261
Theresa Micknick, PAC's National Provider Identifier is 1164774261, issued on Oct 12, 2012. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Carbondale, PA. The record was last updated on Oct 12, 2012.