MEDICARE: MRS. DEBBIE KAY BEANY LPN

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	3747A0650X	Attendant Care Provider	PN 109482-M-IV	OH

General Provider Information

NPI Number	:	1043683915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBBIE KAY BEANY LPN

Provider Business Mailing Address
First Line	:	1376 VALLEY DR
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-9196
Country	:	US
Telephone Number	:	937-578-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	14198 STATE ROUTE 4
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-9048
Country	:	US
Telephone Number	:	937-578-6400
Fax Number	:

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

Provider Enumeration Date	:	11/02/2015
Last Update Date	:	11/02/2015

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