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NPI Code Detail

MEDICARE: JULIE TASKER LPN

MEDICARE: JULIE TASKER LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical NursePN-131416-M-IVOH

General Provider Information

NPI Number : 1063873420
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE TASKER LPN
Provider Business Mailing Address
First Line : 6300 N MAIN ST
Second Line :
City : DAYTON
State : OH
Zip : 45415-3154
Country : US
Telephone Number : 937-275-1500
Fax Number : 937-275-1555
Provider Business Practice Location Address
First Line : 6300 N MAIN ST
Second Line :
City : DAYTON
State : OH
Zip : 45415-3154
Country : US
Telephone Number : 937-275-1500
Fax Number : 937-275-1555
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2016
Last Update Date : 03/14/2016

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