Provider Demographics
NPI:1477647022
Name:SCHROLUCKE, BRIAN EDWIN (LPN)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:EDWIN
Last Name:SCHROLUCKE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3595 OAKLAWN STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224
Mailing Address - Country:US
Mailing Address - Phone:614-784-9023
Mailing Address - Fax:309-104-3663
Practice Address - Street 1:3595 OAKLAWN STREET
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224
Practice Address - Country:US
Practice Address - Phone:614-784-9023
Practice Address - Fax:309-104-3663
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN099831164W00000X
FLPN5148862164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2145495Medicare ID - Type UnspecifiedINDEPENDENT PROVIDER