Basic Information
| Provider Information | |||||||||
| NPI: | 1053823377 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ICKES | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | |||||||||
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| Credential: | NURSE PRACTITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 N SUMMIT ST FL 7 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436041531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192526018 | ||||||||
| FaxNumber: | 8005645952 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 TUCK STREET; MCHS LEBANON / HEARTLAND CARE PARTNERS | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170427446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004271902 | ||||||||
| FaxNumber: | 4195312664 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2017 | ||||||||
| LastUpdateDate: | 10/26/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | SP018005 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.