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NPI Code Detail

MEDICARE: LISA DARLENE WICKEMEIER

MEDICARE: LISA DARLENE WICKEMEIER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical NurseLPN.073380.MEDSOH
2164W00000XLicensed Practical Nurse73380OH

General Provider Information

NPI Number : 1801135934
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA DARLENE WICKEMEIER
Provider Business Mailing Address
First Line : 6460 HARRISON AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45247-7957
Country : US
Telephone Number : 513-941-4999
Fax Number :
Provider Business Practice Location Address
First Line : 6460 HARRISON AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45247-7957
Country : US
Telephone Number : 513-941-4999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2013
Last Update Date : 07/03/2019

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Directions to “ LISA DARLENE WICKEMEIER ” Practice Location

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