Individual
RAYMOND W MICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN180620
OH
363L00000X
Nurse Practitioner
Primary
NP07584
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000344735
ANTHEM
OH
01
—
2355053
RHC MEDICAID FACILITY #
OH
01
—
2355062
RHC MEDICAID 2ND FAC #
OH
05
—
2499005
—
OH
01
—
311674981002
TRI-CARE 2ND FACILITY #
OH
01
—
311674981005
TRI-CARE
OH
01
—
363843
RHC MEDICARE 2ND FAC NUM
OH
01
—
363844
RHC MEDICARE FAC #
OH
Enumeration date
08/16/2005
Last updated
10/02/2012
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