Individual
JEAN ANN MIKRUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED DIETITIAN
Contact information
Practice address
PO BOX 11385, PRESCOTT, AZ 86304-1385
(928) 458-6025
Mailing address
PO BOX 11385, PRESCOTT, AZ 86304-1385
(928) 458-6025
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
727156
AZ
163W00000X
Registered Nurse
Primary
278126
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106736
—
AZ
Enumeration date
06/14/2006
Last updated
07/25/2024
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