=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851650303
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVELYN MAE FLUENT LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2012
-----------------------------------------------------
Last Update Date | 05/03/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 83 PINE ST
-----------------------------------------------------
City | WELLSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14895-1421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-593-6052
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4297 DAVIS HILL RD
-----------------------------------------------------
City | SCIO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14880-9502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-498-3035
-----------------------------------------------------
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 | 298316-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------