Individual
JONI L MIREHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
9443
MN
363AM0700X
Medical Physician Assistant
Primary
5046
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
914655500
—
MN
01
—
970009665
MEDICARE RAILROAD
MN
Enumeration date
09/19/2007
Last updated
10/13/2021
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