Individual
CONNIE HOMERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2035 STATE ROUTE 39, LUCAS, OH 44843-9589
(419) 571-9486
Mailing address
2035 STATE ROUTE 39, LUCAS, OH 44843-9589
(419) 571-9486
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
146955-M-IV
OH
Other
Enumeration date
03/28/2016
Last updated
03/28/2016
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