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General NPI Number Information
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NPI Number | 1154057297
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Entity Type | Individual
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Provider Name | ALISHA LICKWAR WHNP-BC, MSN, RN
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Gender | Female
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Dates
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Enumeration Date | 07/30/2022
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Last Update Date | 07/30/2022
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Provider Practice Location Address
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Address Line | 200 GARFIELD DR NE STE 1
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City | WARREN
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State | OH
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Zip | 44483-5557
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Country | US
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Telephone | 330-372-1828
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Fax |
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Provider Business Mailing Address
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Address Line | 2230 SALT SPRINGS RD
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City | WARREN
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State | OH
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Zip | 44481-9766
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Country | US
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Telephone | 330-394-4597
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 0031856
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License Number State | OH
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