=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609282201
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BELINDA QUIGGLE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2014
-----------------------------------------------------
Last Update Date | 09/03/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 W FRONT ST
-----------------------------------------------------
City | MILAN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44846-9349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-213-6434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33 W FRONT ST P.O. BOX 191
-----------------------------------------------------
City | MILAN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44846-9349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-213-6434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | PN.131278-M-IV
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------