Provider Demographics
NPI:1689391765
Name:MIKERY-MUNOZ, JOANN
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:MIKERY-MUNOZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 WEST ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2524
Mailing Address - Country:US
Mailing Address - Phone:513-293-3492
Mailing Address - Fax:
Practice Address - Street 1:1708 WEST ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:OH
Practice Address - Zip Code:45212-2524
Practice Address - Country:US
Practice Address - Phone:513-293-3492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00740493747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty