Healthcare Provider Details

I. General information

NPI: 1942451513
Provider Name (Legal Business Name): COURTNEY DANIELLE HICE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 DEARTH RD
KINGSTON OH
45644-9528
US

IV. Provider business mailing address

800 DEARTH RD
KINGSTON OH
45644-9528
US

V. Phone/Fax

Practice location:
  • Phone: 740-655-2444
  • Fax:
Mailing address:
  • Phone: 740-655-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN.130535 IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: