Basic Information
| Provider Information | |||||||||
| NPI: | 1336876077 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MICHALSKI | ||||||||
| FirstName: | JACQUELYN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3045 W SCENIC DR | ||||||||
| Address2: | |||||||||
| City: | DANIELSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180389633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107397914 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3445 HIGH POINT BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180177817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108665555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2022 | ||||||||
| LastUpdateDate: | 08/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | MA063490 | PA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.