Healthcare Provider Details

I. General information

NPI: 1407769748
Provider Name (Legal Business Name): MS. VERONICA PAULINE TRICKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8064 SOUTH AVE
YOUNGSTOWN OH
44512-6153
US

IV. Provider business mailing address

230 MELROSE AVE
YOUNGSTOWN OH
44512-2355
US

V. Phone/Fax

Practice location:
  • Phone: 330-290-4974
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN511581
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: