Provider Demographics
NPI:1811102551
Name:KRICKER, LAURA LYNN
Entity type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:LYNN
Last Name:KRICKER
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 1:16 SUGAR CAMP RD
Mailing Address - Street 2:
Mailing Address - City:MINFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45653-8886
Mailing Address - Country:US
Mailing Address - Phone:740-820-5884
Mailing Address - Fax:
Practice Address - Street 1:3900 RHODES AVE
Practice Address - Street 2:APT 509
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4958
Practice Address - Country:US
Practice Address - Phone:740-981-7881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
2708930Medicare UPIN