MEDICARE: MRS. MARILYN JOE MYERS LPN LICENSE

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	374T00000X	Religious Nonmedical Nursing Personnel	PN.117346	OH

General Provider Information

NPI Number	:	1114146727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARILYN JOE MYERS LPN LICENSE

Provider Business Mailing Address
First Line	:	6338 BRUSH LAKE RD
Second Line	:
City	:	NORTH LEWISBURG
State	:	OH
Zip	:	43060-9621
Country	:	US
Telephone Number	:	937-747-3706
Fax Number	:

Provider Business Practice Location Address
First Line	:	6338 BRUSH LAKE RD
Second Line	:
City	:	NORTH LEWISBURG
State	:	OH
Zip	:	43060-9621
Country	:	US
Telephone Number	:	937-747-3706
Fax Number	:

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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