| Doctor Name: | JODI MICSKY |
| NPI Number: | 1245649615 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNP |
| License Number: | RN.296599-COA1 |
| Business Practice Address: | 715 E Western Reserve Rd Poland, OH - 445143358 |
| Business Phone Number: | 3307263204 |
| Business Fax Number: | 3307299316 |
| Mailing Address: | Po Box 636988, CINCINNATI |
| State: | OH |
| Postal Code: | 452636988 |
| Phone Number: | 8889402722 |
| Fax Number: | 5136328898 |
| NPI Enumeration Date: | 08/10/2014 |
| NPI Last Update Date: | 10/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | RN.296599-COA1 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |