MEDICARE: CATHERINE ROOT RN

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	163W00000X	Registered Nurse	RN.358087	OH

General Provider Information

NPI Number	:	1083284905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE ROOT RN

Provider Business Mailing Address
First Line	:	702 SHERMAN ST
Second Line	:
City	:	PANDORA
State	:	OH
Zip	:	45877-9423
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 STERLING DR
Second Line	:
City	:	NORTH BALTIMORE
State	:	OH
Zip	:	45872-9508
Country	:	US
Telephone Number	:	419-257-2421
Fax Number	:

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

Provider Enumeration Date	:	07/01/2021
Last Update Date	:	07/01/2021

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