MEDICARE: PATRICIA STUBBS 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	2009030313	MO

General Provider Information

NPI Number	:	1982078754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA STUBBS LPN

Provider Business Mailing Address
First Line	:	PO DRAWER 459
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	514B E MAIN ST
Second Line	:
City	:	PARK HILLS
State	:	MO
Zip	:	63601-2634
Country	:	US
Telephone Number	:	573-431-0554
Fax Number	:

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

Provider Enumeration Date	:	11/17/2015
Last Update Date	:	11/17/2015

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