Individual
BROOKE ANA MICKAVICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RDN, LDN
Contact information
Practice address
530 S MAIN ST, TAYLOR, PA 18517-1822
(570) 702-7729
Mailing address
530 S MAIN ST, TAYLOR, PA 18517-1822
(570) 702-7729
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN008601
PA
Other
Enumeration date
10/29/2024
Last updated
10/29/2024
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