Provider Demographics
NPI:1104537802
Name:MIKOLETIC, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MIKOLETIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 LINDSEY RD
Mailing Address - Street 2:
Mailing Address - City:MUNROE FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44262-1139
Mailing Address - Country:US
Mailing Address - Phone:330-608-8640
Mailing Address - Fax:
Practice Address - Street 1:178 LINDSEY RD
Practice Address - Street 2:
Practice Address - City:MUNROE FALLS
Practice Address - State:OH
Practice Address - Zip Code:44262-1139
Practice Address - Country:US
Practice Address - Phone:330-608-8640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health