MEDICARE: HASSAN AHMED OVERCOMER 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	164W00000X	Licensed Practical Nurse	PN 124610	OH

General Provider Information

NPI Number	:	1114191780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HASSAN AHMED OVERCOMER LPN

Provider Business Mailing Address
First Line	:	4327 CHESFORD RD APT 2B
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-1751
Country	:	US
Telephone Number	:	614-424-0997
Fax Number	:

Provider Business Practice Location Address
First Line	:	4327 CHESFORD RD APT. 2B
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-1751
Country	:	US
Telephone Number	:	614-424-0997
Fax Number	:

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

Provider Enumeration Date	:	04/15/2008
Last Update Date	:	04/15/2008

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Directions to “ HASSAN AHMED OVERCOMER LPN” Practice Location

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