Provider Demographics
NPI:1104150325
Name:ABBOTT, VICKIE GAIL (LPN)
Entity type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:GAIL
Last Name:ABBOTT
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 1:5256 ARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-1306
Mailing Address - Country:US
Mailing Address - Phone:330-896-0549
Mailing Address - Fax:
Practice Address - Street 1:5256 ARLINGTON RD
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-1306
Practice Address - Country:US
Practice Address - Phone:330-896-0549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.092599164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse