Provider Demographics
NPI:1295356632
Name:RODDY-LANIER, VICKIE L
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:L
Last Name:RODDY-LANIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VICKIE
Other - Middle Name:L
Other - Last Name:RODDY-LANIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1186 FABER AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-2643
Mailing Address - Country:US
Mailing Address - Phone:614-625-2312
Mailing Address - Fax:
Practice Address - Street 1:1186 FABER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-2643
Practice Address - Country:US
Practice Address - Phone:614-491-0846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN474323163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse