MEDICARE: MISS CAMISHA LOUISE MAZE LPN

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	164W00000X	Licensed Practical Nurse	PN112204	OH

General Provider Information

NPI Number	:	1841486388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CAMISHA LOUISE MAZE LPN

Provider Business Mailing Address
First Line	:	2124 AUBURN AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-2912
Country	:	US
Telephone Number	:	937-367-1547
Fax Number	:

Provider Business Practice Location Address
First Line	:	2124 AUBURN AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-2912
Country	:	US
Telephone Number	:	937-367-1547
Fax Number	:

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

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	06/27/2008

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Directions to “ MISS CAMISHA LOUISE MAZE LPN” Practice Location

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