Provider Demographics
NPI:1467969477
Name:MIKACH, CAROLINE FOGLEMAN (CRNA)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:FOGLEMAN
Last Name:MIKACH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:JOYCE
Other - Last Name:FOGLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:208 SHOALS POINT TRL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35757-6816
Mailing Address - Country:US
Mailing Address - Phone:205-475-3016
Mailing Address - Fax:
Practice Address - Street 1:700 W MARKET ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2457
Practice Address - Country:US
Practice Address - Phone:256-233-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-135557367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered