Provider Demographics
NPI:1205146693
Name:HEISLE, RICKITA LYNN (RN)
Entity type:Individual
Prefix:MS
First Name:RICKITA
Middle Name:LYNN
Last Name:HEISLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:RICKITA
Other - Middle Name:LYNN
Other - Last Name:SAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:5979 RENA PLACE
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-4316
Mailing Address - Country:US
Mailing Address - Phone:937-270-1659
Mailing Address - Fax:
Practice Address - Street 1:5979 RENA PL
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-4316
Practice Address - Country:US
Practice Address - Phone:937-270-1659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN522357163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse