Provider Demographics
NPI:1932422656
Name:STICE, TERRI YVETTE (LPN)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:YVETTE
Last Name:STICE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:T
Other - Middle Name:Y
Other - Last Name:WATKINS -POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:690 WINSHOLEN CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3769
Mailing Address - Country:US
Mailing Address - Phone:614-458-8656
Mailing Address - Fax:614-748-0590
Practice Address - Street 1:690 WINSHOLEN CT
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3769
Practice Address - Country:US
Practice Address - Phone:614-458-8656
Practice Address - Fax:614-748-0590
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH095519164W00000X
FLPN5187717164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse