MEDICARE: MRS. DARLENE MARIE FLUELLEN

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	164W00000X	Licensed Practical Nurse	PN111785	OH

General Provider Information

NPI Number	:	1083834469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DARLENE MARIE FLUELLEN

Provider Business Mailing Address
First Line	:	2119 ROSSMOOR RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2516
Country	:	US
Telephone Number	:	216-321-1337
Fax Number	:	216-321-1337

Provider Business Practice Location Address
First Line	:	2119 ROSSMOOR RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2516
Country	:	US
Telephone Number	:	216-321-1337
Fax Number	:	216-321-1337

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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