=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629343553
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARLENE CARRIE ANNE YORK LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2012
-----------------------------------------------------
Last Update Date | 12/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3514 CURVING OAKS WAY
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32820-2752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-690-9115
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17610 STATE ROUTE 136
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45697-9422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-690-9808
-----------------------------------------------------
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-145431-MEDS
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | PN5213562
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------