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NPI Code Detail

MEDICARE: NANCY MCCALLA LPN

MEDICARE:   NANCY  MCCALLA  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 NurseLPN.165971.MEDS-IVOH

General Provider Information

NPI Number : 1104530005
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY MCCALLA LPN
Provider Business Mailing Address
First Line : 3611 WOLF RD SW
Second Line :
City : PORT WASHINGTON
State : OH
Zip : 43837-9227
Country : US
Telephone Number : 330-987-1927
Fax Number :
Provider Business Practice Location Address
First Line : 1260 MONROE ST NW
Second Line :
City : NEW PHILA
State : OH
Zip : 44663-4160
Country : US
Telephone Number : 330-602-5339
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2023
Last Update Date : 01/06/2023

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Directions to “ NANCY MCCALLA LPN” Practice Location

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