MEDICARE: MRS. MARY ANDERSON 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	163WH0200X	Home Health Registered Nurse	338989	OH

General Provider Information

NPI Number	:	1750674099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ANDERSON RN

Provider Business Mailing Address
First Line	:	24366 BUSHBY RD
Second Line	:
City	:	SOUTH BLOOMINGVILLE
State	:	OH
Zip	:	43152-9712
Country	:	US
Telephone Number	:	740-332-1549
Fax Number	:

Provider Business Practice Location Address
First Line	:	24366 BUSHBY RD
Second Line	:
City	:	SOUTH BLOOMINGVILLE
State	:	OH
Zip	:	43152-9712
Country	:	US
Telephone Number	:	740-332-1549
Fax Number	:

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

Provider Enumeration Date	:	05/19/2011
Last Update Date	:	05/19/2011

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