MEDICARE: CARRIE DAWN JUSTICE RN

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	163W00000X	Registered Nurse	RN275141	OH

General Provider Information

NPI Number	:	1720069966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE DAWN JUSTICE RN

Provider Business Mailing Address
First Line	:	1256 C HOUSTON HOLLOW
Second Line	:
City	:	LUCASVILLE
State	:	OH
Zip	:	45648
Country	:	US
Telephone Number	:	740-727-4615
Fax Number	:

Provider Business Practice Location Address
First Line	:	1256 HOUSTON HOLLOW LONG RUN RD
Second Line	:	C
City	:	LUCASVILLE
State	:	OH
Zip	:	45648-8426
Country	:	US
Telephone Number	:	740-727-4615
Fax Number	:

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	06/14/2010

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