Individual
SEAN MICKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
(910) 939-4859
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA055566
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA0055566
STATE LICENSE
PA
Enumeration date
08/16/2012
Last updated
03/06/2021
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