Provider Demographics
NPI:1538201918
Name:CRIDER, NANCY SUE (LPN)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:SUE
Last Name:CRIDER
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 1:96 SHARON RD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2019
Mailing Address - Country:US
Mailing Address - Phone:740-656-6321
Mailing Address - Fax:
Practice Address - Street 1:96 SHARON RD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2019
Practice Address - Country:US
Practice Address - Phone:740-656-6321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN089055164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1538201918Medicaid
OH2588356Medicaid