MEDICARE: MRS. CONNIE SUE DALZELL-TARR R.N.

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	RN 253818	OH

General Provider Information

NPI Number	:	1851619977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CONNIE SUE DALZELL-TARR R.N.

Provider Business Mailing Address
First Line	:	2409 CEDAR CHAPEL RD
Second Line	:
City	:	HILLSBORO
State	:	OH
Zip	:	45133-8639
Country	:	US
Telephone Number	:	937-588-5141
Fax Number	:	937-588-4000

Provider Business Practice Location Address
First Line	:	2409 CEDAR CHAPEL RD
Second Line	:
City	:	HILLSBORO
State	:	OH
Zip	:	45133-8639
Country	:	US
Telephone Number	:	937-588-5141
Fax Number	:	937-588-4000

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

Provider Enumeration Date	:	05/13/2010
Last Update Date	:	05/13/2010

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