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General NPI Number Information
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NPI Number | 1437141561
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Entity Type | Individual
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Provider Name | RAYMOND W MICK CNP
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Gender | Male
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 1092 JEFFERSON ST
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City | GREENFIELD
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State | OH
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Zip | 45123-8319
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Country | US
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Telephone | 937-981-1121
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Fax | 937-981-5660
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Provider Business Mailing Address
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Address Line | PO BOX 637736
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City | CINCINNATI
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State | OH
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Zip | 45263-7736
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Country | US
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Telephone | 513-891-1006
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Fax | 513-793-1032
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN180620
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP07584
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License Number State | OH
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