Individual
RECIA MICKENS-LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
717 S 30TH ST, HEATH, OH 43056-1294
(248) 470-3247
Mailing address
359 OAK HILL DR, WESTERVILLE, OH 43081-3420
(248) 470-3247
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
026471
OH
363LG0600X
Gerontology Nurse Practitioner
Primary
026471
OH
Other
Enumeration date
09/18/2020
Last updated
09/18/2020
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