MEDICARE: MS. DARNETTA METCALF 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	PN116034	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154643757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DARNETTA METCALF LPN

Provider Business Mailing Address
First Line	:	4515 ALLISON ST
Second Line	:	BOX 12087
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2601
Country	:	US
Telephone Number	:	513-526-9377
Fax Number	:

Provider Business Practice Location Address
First Line	:	4515 ALLISON ST
Second Line	:	BOX 12087
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2601
Country	:	US
Telephone Number	:	513-526-9377
Fax Number	:

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

Provider Enumeration Date	:	02/23/2010
Last Update Date	:	04/29/2010

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