Individual
CAMILLE MARIE MIKLACIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
21 E WALNUT ST, JEFFERSON, OH 44047-1119
(440) 576-3372
Mailing address
21 E WALNUT ST, JEFFERSON, OH 44047-1119
(440) 576-3372
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN113985
OH
Other
Enumeration date
08/26/2009
Last updated
08/26/2009
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