Individual
KELLI MARIE MIKOLOSKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1200 S CEDAR CREST BLVD, ALLENTOWN, PA 18103-6202
(610) 402-9099
(610) 402-9029
Mailing address
1245 S CEDAR CREST BLVD STE 301, ALLENTOWN, PA 18103-6258
(610) 402-9099
(610) 402-9029
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN-564095
PA
367500000X
Certified Registered Nurse Anesthetist
Primary
082609
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1027800840001
—
PA
01
—
11976788
CAQH
PA
01
—
127848
GEISINGER
PA
01
—
1585159
GATEWAY
PA
01
—
2112787
HIGHMARK
PA
01
—
3723133000
IBC
PA
01
—
50086413
CAPITAL ADVANTAGE
PA
01
—
9769481
AETNA
PA
Enumeration date
06/19/2009
Last updated
03/25/2013
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