MEDICARE: MISS LOLITA MICHELLE SULLINS

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	376K00000X	Nurse's Aide	401644820514	OH

General Provider Information

NPI Number	:	1023421716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LOLITA MICHELLE SULLINS

Provider Business Mailing Address
First Line	:	5303 NORTHFIELD RD
Second Line	:	814
City	:	BEDFORD HEIGHTS
State	:	OH
Zip	:	44146-1104
Country	:	US
Telephone Number	:	216-253-6268
Fax Number	:

Provider Business Practice Location Address
First Line	:	5303 NORTHFIELD RD
Second Line	:	814
City	:	BEDFORD HEIGHTS
State	:	OH
Zip	:	44146-1104
Country	:	US
Telephone Number	:	216-253-6268
Fax Number	:

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

Provider Enumeration Date	:	06/10/2014
Last Update Date	:	06/10/2014

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Directions to “ MISS LOLITA MICHELLE SULLINS ” Practice Location

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