Provider Demographics
NPI:1053443564
Name:CAUGHMAN, ALICE JEAN (LPN)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:JEAN
Last Name:CAUGHMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12980 DOVER COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-8920
Mailing Address - Country:US
Mailing Address - Phone:937-644-9013
Mailing Address - Fax:937-644-9013
Practice Address - Street 1:12980 DOVER COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-8920
Practice Address - Country:US
Practice Address - Phone:937-644-9013
Practice Address - Fax:937-644-9013
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2211690164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2211690Medicaid