Provider Demographics
NPI:1063206431
Name:MIKA, RICHARD (RN)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MIKA
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 CUMMING AVE
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-2740
Mailing Address - Country:US
Mailing Address - Phone:715-413-0165
Mailing Address - Fax:
Practice Address - Street 1:2011 CUMMING AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-2740
Practice Address - Country:US
Practice Address - Phone:715-413-0165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2519937163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse