Provider Demographics
NPI:1689004574
Name:MIKSIC, ERIN (CNM)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MIKSIC
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14008 SHADOWGLEN BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-3406
Mailing Address - Country:US
Mailing Address - Phone:512-445-4800
Mailing Address - Fax:
Practice Address - Street 1:14008 SHADOWGLEN BLVD STE 302
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-3406
Practice Address - Country:US
Practice Address - Phone:512-445-4800
Practice Address - Fax:512-308-9649
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001574367A00000X
WAAP60643407367A00000X
TXAP134661367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2058318Medicaid