Provider Demographics
NPI:1790074193
Name:ENGRAM, VICKI M (LPN)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:M
Last Name:ENGRAM
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 1:2596 CHAMBERLAIN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4143
Mailing Address - Country:US
Mailing Address - Phone:330-786-7772
Mailing Address - Fax:330-548-3822
Practice Address - Street 1:2596 CHAMBERLAIN RD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4143
Practice Address - Country:US
Practice Address - Phone:330-786-7772
Practice Address - Fax:330-548-3822
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-142097164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse