Provider Demographics
NPI:1669881462
Name:GLICK, RANDI (LPN)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:GLICK
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 1:200 E LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45814-9687
Mailing Address - Country:US
Mailing Address - Phone:419-889-7642
Mailing Address - Fax:
Practice Address - Street 1:200 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:45814-9687
Practice Address - Country:US
Practice Address - Phone:419-889-7642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH154537-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse