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Individual

CAROL LEE ICKES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1243 SHED RD, BEDFORD, PA 15522-8584
(814) 623-5166
Mailing address
1243 SHED RD, BEDFORD, PA 15522-8584
(814) 623-5166

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN505244L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
RN505244L
LICENSE
PA
Enumeration date
02/08/2019
Last updated
02/08/2019
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