Healthcare Provider Details

I. General information

NPI: 1679284293
Provider Name (Legal Business Name): CARRIE SUE BICKFORD LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE SUE CLARK LPN

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 JOHN GLENN HWY
CAMBRIDGE OH
43725-9028
US

IV. Provider business mailing address

2845 BELL ST
ZANESVILLE OH
43701-1720
US

V. Phone/Fax

Practice location:
  • Phone: 740-439-4428
  • Fax: 740-439-3389
Mailing address:
  • Phone: 740-454-9766
  • Fax: 740-588-6452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.107485.MEDS
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: