MEDICARE: MISS LAURA LYNN KRICKER

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
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1811102551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LAURA LYNN KRICKER

Provider Business Mailing Address
First Line	:	16 SUGAR CAMP RD
Second Line	:
City	:	MINFORD
State	:	OH
Zip	:	45653-8886
Country	:	US
Telephone Number	:	740-820-5884
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 RHODES AVE
Second Line	:	APT 509
City	:	PORTSMOUTH
State	:	OH
Zip	:	45662-4958
Country	:	US
Telephone Number	:	740-981-7881
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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