| Doctor Name: | STACY LEE MIKUSZEWSKI |
| NPI Number: | 1659789105 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSN, CRNP |
| License Number: | SP013964 |
| Business Practice Address: | 401 Broad Ave Susquehanna, PA - 188471611 |
| Business Phone Number: | 5708533995 |
| Business Fax Number: | 5708533728 |
| Mailing Address: | 401 Broad Ave, SUSQUEHANNA |
| State: | PA |
| Postal Code: | 188471611 |
| Phone Number: | 5708533995 |
| Fax Number: | 5708533728 |
| NPI Enumeration Date: | 07/29/2014 |
| NPI Last Update Date: | 07/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | SP013964 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |