Provider Demographics
NPI:1790984417
Name:BRICKER, MARILYN JEAN (LPN)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:JEAN
Last Name:BRICKER
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 1:58 HALDY AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-2655
Mailing Address - Country:US
Mailing Address - Phone:614-260-6203
Mailing Address - Fax:614-405-7374
Practice Address - Street 1:58 HALDY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-2655
Practice Address - Country:US
Practice Address - Phone:614-260-6203
Practice Address - Fax:614-405-7374
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN084666164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2239732Medicaid