Provider Demographics
NPI:1740703040
Name:VANSICKLE, RICK DALE (LPN)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:DALE
Last Name:VANSICKLE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 W MARKET ST STE 2
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3318
Mailing Address - Country:US
Mailing Address - Phone:330-606-9561
Mailing Address - Fax:
Practice Address - Street 1:3250 WEST MARKET
Practice Address - Street 2:SUITE 2
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333
Practice Address - Country:US
Practice Address - Phone:330-606-9561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.157266.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse