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NPI Code Detail

MEDICARE: CAROLYN VANDERMARK

MEDICARE: CAROLYN VANDERMARK
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 NursePN153433-M-IVOH

General Provider Information

NPI Number : 1407215189
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN VANDERMARK
Provider Business Mailing Address
First Line : 25 WHITNEY DR
Second Line :
City : MILFORD
State : OH
Zip : 45150-8402
Country : US
Telephone Number : 513-969-8768
Fax Number :
Provider Business Practice Location Address
First Line : 25 WHITNEY DR
Second Line :
City : MILFORD
State : OH
Zip : 45150-8402
Country : US
Telephone Number : 513-969-8768
Fax Number : 937-258-4261
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2016
Last Update Date : 03/01/2024

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Directions to “ CAROLYN VANDERMARK ” Practice Location

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