Individual
IDA G VICKERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
817 MILLSTREAM RUN, MACEDONIA, OH 44056-1564
(216) 533-3592
Mailing address
817 MILLSTREAM RUN, MACEDONIA, OH 44056-1564
(216) 533-3592
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN.140816-M-IV
OH
Other
Enumeration date
11/01/2010
Last updated
11/01/2010
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