MEDICARE: MYRIAM EMANUEL

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
1	164W00000X	Licensed Practical Nurse	RN.343552	OH
2	163W00000X	Registered Nurse	343552	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073892667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRIAM EMANUEL

Provider Business Mailing Address
First Line	:	1515 BETHEL RD STE 304
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-2056
Country	:	US
Telephone Number	:	614-641-7590
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 BETHEL RD STE 304
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-2056
Country	:	US
Telephone Number	:	614-641-7590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2011
Last Update Date	:	11/07/2022

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Directions to “ MYRIAM EMANUEL ” Practice Location

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