Basic Information
| Provider Information | |||||||||
| NPI: | 1306491147 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIKNIS | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | AARON | ||||||||
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| Credential: | CRNP, AGACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 STONEBRIDGE DR | ||||||||
| Address2: | |||||||||
| City: | DILLSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170198310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7174190712 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1995 TECHNOLOGY PKWY | ||||||||
| Address2: | |||||||||
| City: | MECHANICSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170508522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172318772 | ||||||||
| FaxNumber: | 7172318435 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2019 | ||||||||
| LastUpdateDate: | 01/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | SP020575 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LC0200X | SP020575 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Critical Care Medicine | 363LG0600X | SP020575 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LA2100X | SP020575 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.