Provider Demographics
NPI:1558243170
Name:LICHT, CARRIE (CNP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:LICHT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 MYERS ST
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:OH
Mailing Address - Zip Code:44217-9704
Mailing Address - Country:US
Mailing Address - Phone:912-467-3215
Mailing Address - Fax:
Practice Address - Street 1:1761 BEALL AVE
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2342
Practice Address - Country:US
Practice Address - Phone:330-263-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0039851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily