Individual
MRS. JOVANNA ROSE MICKIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1001 SAM PERRY, FREDERICKSBURG, VA 22408-1822
(540) 741-1167
Mailing address
1001 SAM PERRY, FREDERICKSBURG, VA 22408-1822
(540) 741-1167
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110002468
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0110002468
—
VA
Enumeration date
05/16/2009
Last updated
11/08/2012
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