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General NPI Number Information
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NPI Number | 1912283060
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Entity Type | Individual
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Provider Name | SUE ANN FICKEL NP-C
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Gender | Female
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Dates
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Enumeration Date | 11/02/2011
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Last Update Date | 11/02/2011
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Provider Practice Location Address
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Address Line | 140 FOX RD SUITE #304
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City | VAN WERT
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State | OH
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Zip | 45891-2475
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Country | US
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Telephone | 419-238-6747
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Fax |
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Provider Business Mailing Address
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Address Line | 18665 ROAD 18R
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City | COLUMBUS GROVE
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State | OH
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Zip | 45830-9252
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Country | US
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Telephone | 419-642-4885
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | COA.12812-NP
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License Number State | OH
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