Provider Demographics
NPI:1821216813
Name:DUKES, VICKI C (LPN)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:C
Last Name:DUKES
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 1:1625 GENOA PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-2424
Mailing Address - Country:US
Mailing Address - Phone:614-804-2989
Mailing Address - Fax:
Practice Address - Street 1:201 S WEYANT AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1640
Practice Address - Country:US
Practice Address - Phone:614-670-5682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN082439164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN082439OtherLICENSED PRACTICAL NURSE
OH2492815Medicaid