Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | CNP020201 | OH |
NPI | 1023567880 |
---|---|
Provider Name | Heidi Vickers |
First Address | Columbus, OH 43221-2849 |
Second Address | Columbus, OH 43221-2849 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2016 |
Last Update Date | 16/11/2016 |