Provider Demographics
NPI:1770885295
Name:BICKLEY, DAN FERRELL JR (RN)
Entity type:Individual
Prefix:MR
First Name:DAN
Middle Name:FERRELL
Last Name:BICKLEY
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8827 STONE LN NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7941
Mailing Address - Country:US
Mailing Address - Phone:330-322-9063
Mailing Address - Fax:
Practice Address - Street 1:8827 STONE LN NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7941
Practice Address - Country:US
Practice Address - Phone:330-322-9063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-04
Last Update Date:2010-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH359853163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse