Healthcare Provider Details

I. General information

NPI: 1639380751
Provider Name (Legal Business Name): JANEL D VANSICKLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2582 SHAKESPEARE LN
AVON OH
44011-1929
US

IV. Provider business mailing address

2582 SHAKESPEARE LN
AVON OH
44011-1929
US

V. Phone/Fax

Practice location:
  • Phone: 216-544-8113
  • Fax: 216-445-3692
Mailing address:
  • Phone: 216-544-8113
  • Fax: 216-445-3692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN301872
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: