Basic Information
| Provider Information | |||||||||
| NPI: | 1376144998 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PSENICK | ||||||||
| FirstName: | MIKAYLA | ||||||||
| MiddleName: | RAE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 502 QUAIL DR | ||||||||
| Address2: | |||||||||
| City: | CRANBERRY TWP | ||||||||
| State: | PA | ||||||||
| PostalCode: | 160664074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245913583 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2315 MYRTLE ST STE L10 | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165024611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144542401 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2020 | ||||||||
| LastUpdateDate: | 07/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA061973 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.