MEDICARE: HANNAH COLEAN MCFADDEN LMT

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	164X00000X	Licensed Vocational Nurse	MA63884	FL

General Provider Information

NPI Number	:	1245634328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH COLEAN MCFADDEN LMT

Provider Business Mailing Address
First Line	:	10407 LAKE GROVE DR
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-2508
Country	:	US
Telephone Number	:	813-525-0191
Fax Number	:

Provider Business Practice Location Address
First Line	:	10407 LAKE GROVE DR
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-2508
Country	:	US
Telephone Number	:	813-525-0191
Fax Number	:

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

Provider Enumeration Date	:	10/17/2014
Last Update Date	:	10/17/2014

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