Provider Demographics
NPI:1821701889
Name:BRICKEY, ROBERT EDWIN III (LVN)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EDWIN
Last Name:BRICKEY
Suffix:III
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18277 BOWMAN RD
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96022-9303
Mailing Address - Country:US
Mailing Address - Phone:530-276-1726
Mailing Address - Fax:
Practice Address - Street 1:18277 BOWMAN RD
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:CA
Practice Address - Zip Code:96022-9303
Practice Address - Country:US
Practice Address - Phone:530-276-1726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA242249164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse