=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194302992
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | I CAN NURSING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2021
-----------------------------------------------------
Last Update Date | 03/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 267 UNION ROAD 81
-----------------------------------------------------
City | MOUNT HOLLY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71758-6064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-863-2041
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 267 UNION ROAD 81
-----------------------------------------------------
City | MOUNT HOLLY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71758-6064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-863-2041
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | ELIZABETH ANN FORD
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 800-863-2041
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------