Individual
ALICE RAIN TACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
55 W WATERLOO RD, AKRON, OH 44319-1116
(330) 724-7715
(216) 229-6048
Mailing address
10701 EAST BLVD, CLEVELAND, OH 44106-1702
(216) 791-3800
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN-114579MEDS
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPN-114579MEDS
LPN
OH
Enumeration date
12/02/2022
Last updated
12/02/2022
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