Provider Demographics
NPI:1871513762
Name:MIKLOVICH, ROBYN J (CNP)
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:J
Last Name:MIKLOVICH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-3781
Mailing Address - Country:US
Mailing Address - Phone:440-240-1655
Mailing Address - Fax:440-245-1218
Practice Address - Street 1:1800 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-3781
Practice Address - Country:US
Practice Address - Phone:440-240-1655
Practice Address - Fax:440-245-1218
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0249-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000526145OtherANTHEM
OH2053012Medicaid
OH000000221287OtherUNISON
OH7051573OtherAETNA
OHP00412507OtherRAILROAD MEDICARE
OHS67207Medicare UPIN
OHMINP01824Medicare PIN
OH000000526145OtherANTHEM