MEDICARE: LORA LYNN FIELDING AID

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1194987172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORA LYNN FIELDING AID

Provider Business Mailing Address
First Line	:	5680 CALLAHAN RD
Second Line	:
City	:	SOUTH VIENNA
State	:	OH
Zip	:	45369-9715
Country	:	US
Telephone Number	:	937-408-8141
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 E COLUMBUS RD APT 214
Second Line	:
City	:	SOUTH CHARLESTON
State	:	OH
Zip	:	45368-9335
Country	:	US
Telephone Number	:	937-462-7420
Fax Number	:

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

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	01/10/2010

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