Provider Demographics
NPI:1154057297
Name:LICKWAR, ALISHA (WHNP-BC, MSN, RN)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:LICKWAR
Suffix:
Gender:F
Credentials:WHNP-BC, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 SALT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481-9766
Mailing Address - Country:US
Mailing Address - Phone:330-394-4597
Mailing Address - Fax:
Practice Address - Street 1:200 GARFIELD DR NE STE 1
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-5557
Practice Address - Country:US
Practice Address - Phone:330-372-1828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-30
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0031856363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health