Provider Demographics
NPI:1851169346
Name:LAW, VICKI
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:LAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12841 MONTGOMERY HWY
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:AL
Mailing Address - Zip Code:36049-5234
Mailing Address - Country:US
Mailing Address - Phone:334-391-8159
Mailing Address - Fax:
Practice Address - Street 1:12841 MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:AL
Practice Address - Zip Code:36049-5234
Practice Address - Country:US
Practice Address - Phone:334-391-8159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider