MEDICARE: CHARLOTTE LYNN HACK

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	376K00000X	Nurse's Aide	401815311215	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	:	1619416443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE LYNN HACK

Provider Business Mailing Address
First Line	:	6538 MARKET ST.
Second Line	:
City	:	BOARDMAN
State	:	OH
Zip	:	44512
Country	:	US
Telephone Number	:	330-549-9699
Fax Number	:	330-549-0383

Provider Business Practice Location Address
First Line	:	12236 MARKET ST
Second Line	:
City	:	NORTH LIMA
State	:	OH
Zip	:	44452-9770
Country	:	US
Telephone Number	:	330-718-6698
Fax Number	:	330-549-0383

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

Provider Enumeration Date	:	02/13/2017
Last Update Date	:	04/25/2017

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Directions to “ CHARLOTTE LYNN HACK ” Practice Location

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