MRS. THERESA MICKNICK (NPI# 1164774261) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164774261 |
| Entity Type | Individual |
| Full Name | MRS. THERESA MICKNICK |
| Other Name | MR. THERESA WHITE |
| Credential | PAC |
| Practice Address |
165 Fallbrook St Carbondale PA 18433 |
| Mailing Address |
217 Bell Mountain Rd Jermyn PA 18433-3611 |
| Practice Telephone | 5702823151 |
| Mailing Telephone | 5702544663 |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2012-10-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
MA001651L | PA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
165 FALLBROOK ST |
| City | CARBONDALE |
| State | PA |
| Zip Code | 18433 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184746042 | Tamrat Bekele Md | Internal Medicine | 165 Fallbrook St, Carbondale, PA 18407-1810 | 2007-04-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265918940 | Andrew Brown's Drug Store, Inc. | Pharmacy | 5 Washington Ave, Suite One, Jermyn, PA 18433 | 2018-07-16 |
| 1538615380 | Peterjason Ligi | Dietitian, Registered | 122 5th St, Mayfield, PA 18433 | 2016-08-31 |
| 1215059001 | Patrick Thomas Hayes | Dentist | 314 Rushbrook St, Jermyn, PA 18433 | 2007-04-04 |
| 1033252523 | Sterling Pharmacy,inc. | Pharmacy | 547 Washington Ave, Jermyn, PA 18433 | 2007-02-14 |
| 1710090824 | Nancy Greer | Nurse Practitioner | 5 S Washington Avenue, Jermyn, PA 18433 | 2006-08-16 |
| 1164439006 | Scranton Temple Residency Program Faculty Service | Internal Medicine | 5 S. Washington Ave, Jermyn, PA 18433 | 2006-08-02 |
| 1205892999 | Bhupendra Rambhai Patel Sr. | Internal Medicine | 512 Lackawanna Avenue, Mayfield, PA 18433 | 2006-04-22 |
| 1336639244 | Vitz Medical LLC | Clinic/Center | 504 1/2 Scranton Carbondale Hwy, Mayfield, PA 18433 | 2018-05-16 |
| 1043522402 | Jumee Barooah | Internal Medicine | 5 S Washington Ave, Jermyn, PA 18433 | 2010-07-13 |
| 1497956411 | Gregg J. Novak | Internal Medicine | 5 S Washington Ave, Jermyn, PA 18433 | 2007-05-29 |
| Find all providers in zip 18433 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336605237 | Macy L Henson | Physician Assistant | 305 W Jackson St Ste 200, Carbondale, IL 62901-1474 | 2019-02-15 |
| 1659741312 | Morgan Echols | Physician Assistant | 405 W Jackson St, Carbondale, IL 62901-1462 | 2015-10-06 |
| 1255618237 | Alexis Elizabeth Lorinskas | Physician Assistant | 202 W Jackson St, Carbondale, IL 62901-1409 | 2011-11-04 |
| 1093025272 | Ann Bridget Diehl | Physician Assistant | 254 Brooklyn St, Carbondale, PA 18407-2824 | 2010-10-20 |
| 1225364219 | Alicia K Cremeens | Physician Assistant | 2601 W Main St, Carbondale, IL 62901-1031 | 2009-10-26 |
| 1376673582 | Ivy Jane Chalmers | Physician Assistant | 978 Euclid Ave, Carbondale, CO 81623-1820 | 2007-03-06 |
| 1962549790 | Jenifer Marie Chambless | Physician Assistant | 305 W Jackson St, Suite 200, Carbondale, IL 62901-1474 | 2007-01-31 |
| 1679511281 | Mary Rosenhauer | Physician Assistant | 1350 Cedar Ct, Carbondale, IL 62901-5336 | 2006-06-04 |
| 1972589919 | Max A Baier | Physician Assistant | 305 W Jackson St, Suite 200, Carbondale, IL 62901-1474 | 2005-12-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497355341 | Julia Majewicz Wilson | Physician Assistant | 111 Pa-715, #102, Brodheadsville, PA 18322 | 2020-10-29 |
| 1417557273 | Jared Michael Yon | Physician Assistant | 902 Dale Ave, Bradfordwoods, PA 15015-1236 | 2020-10-29 |
| 1295335230 | Jillian Ann Korgeski | Physician Assistant | 400 Corner St, Dunmore, PA 18512-2348 | 2020-10-29 |
| 1821697376 | Sidney Patel | Physician Assistant | 1834 Oregon Pike Ste 20, Lancaster, PA 17601-6463 | 2020-10-25 |
| 1629677356 | Jason Christopher Takacs Jr. | Physician Assistant | 510 Stockton Rdg, Cranberry Township, PA 16066-2280 | 2020-10-23 |
| 1467051763 | Molly Catherine Peters | Physician Assistant | 4338 Boone St, Philadelphia, PA 19128-4901 | 2020-10-19 |
| 1508465840 | Tran Quyen Tran | Physician Assistant | 2941 Hillside Rd, Broomall, PA 19008-1304 | 2020-10-19 |
| 1275132656 | Jessica Haley Stecklein | Physician Assistant | 696 Fir Ave, Langhorne, PA 19047-5450 | 2020-10-18 |
| 1083212625 | Kele Ferreira | Physician Assistant | 1201 Sandhill Rd, Lebanon, PA 17046-1943 | 2020-10-15 |
| 1386251619 | Nicholas James Lazorka | Physician Assistant | 195 Chapmans Round Top Rd, Montoursville, PA 17754-7508 | 2020-09-30 |
| Find all providers with the same taxonomy | ||||
| City | CARBONDALE |
| Zip Code | 18433 |
Please comment or provide details below to improve the information on MRS. THERESA MICKNICK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.