Provider Demographics
NPI:1447032040
Name:POLITES, MIKAYLA ROSE (CRNP)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:ROSE
Last Name:POLITES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 HILLS PLZ STE 530
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-4220
Mailing Address - Country:US
Mailing Address - Phone:814-419-8084
Mailing Address - Fax:
Practice Address - Street 1:881 HILLS PLZ STE 530
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4220
Practice Address - Country:US
Practice Address - Phone:814-419-8084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028399363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily