Provider Demographics
NPI:1114092137
Name:MIKSCH, PAULETTE MARIE (ANP)
Entity Type:Individual
Prefix:MS
First Name:PAULETTE
Middle Name:MARIE
Last Name:MIKSCH
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12710 VOYAGER PARKWAY
Mailing Address - Street 2:NORTH BUILDING
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921
Mailing Address - Country:US
Mailing Address - Phone:719-432-0725
Mailing Address - Fax:719-432-0722
Practice Address - Street 1:12710 VOYAGER PARKWAY
Practice Address - Street 2:NORTH BUILDING
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921
Practice Address - Country:US
Practice Address - Phone:719-432-0725
Practice Address - Fax:719-432-0722
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43441363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P36554Medicare UPIN