Provider Demographics
NPI:1063626885
Name:PILCK, MARY CECELIA (LPN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CECELIA
Last Name:PILCK
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 1:13778 FINLEY RD
Mailing Address - Street 2:
Mailing Address - City:SENECAVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43780-9731
Mailing Address - Country:US
Mailing Address - Phone:740-685-3866
Mailing Address - Fax:
Practice Address - Street 1:17623 EASTON RD
Practice Address - Street 2:
Practice Address - City:SALESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43778-9878
Practice Address - Country:US
Practice Address - Phone:740-489-5576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 065568164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse