Provider Demographics
NPI:1720253040
Name:VICKERS, ISHA SHANTE (LPN)
Entity Type:Individual
Prefix:MS
First Name:ISHA
Middle Name:SHANTE
Last Name:VICKERS
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 1:97 JEWETT ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-2313
Mailing Address - Country:US
Mailing Address - Phone:330-634-6397
Mailing Address - Fax:
Practice Address - Street 1:97 JEWETT ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305-2313
Practice Address - Country:US
Practice Address - Phone:330-634-6397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH130040-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse