Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | SP020575 | PA |
N | 363LA2200X | Nurse Practitioner - Adult Health | SP020575 | PA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | SP020575 | PA |
N | 363LG0600X | Nurse Practitioner - Gerontology | SP020575 | PA |
NPI | 1306491147 |
---|---|
Provider Name | Jonathan Aaron Miknis |
First Address | Dillsburg, PA 17019-8310 |
Second Address | Mechanicsburg, PA 17050-8522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2019 |
Last Update Date | 27/01/2021 |