| Doctor Name: | JESSICA ELAINE MIKOLAICHIK |
| NPI Number: | 1568875870 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-HIS |
| License Number: | F03277 |
| Business Practice Address: | 195 Stock St Suite 112 Hanover, PA - 173312266 |
| Business Phone Number: | 7176981541 |
| Business Fax Number: | 7176981430 |
| Mailing Address: | 195 Stock St, Suite 112 HANOVER |
| State: | PA |
| Postal Code: | 173312266 |
| Phone Number: | 7176981541 |
| Fax Number: | 7176981430 |
| NPI Enumeration Date: | 06/04/2014 |
| NPI Last Update Date: | 03/07/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246Z00000X |
| License Number: | F03277 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Specialist/Technologist, Other |
| Taxonomy Specialization: | |
| Taxonomy Definition: | General classification identifying individuals trained on specific equipment and technical procedures in one of a collection of miscellaneous healthcare disciplines. |