MEDICARE: MISS PATRICIA ANQUINETTE CUMMINGS LVN

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	164X00000X	Licensed Vocational Nurse	180002	TX

General Provider Information

NPI Number	:	1164618971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PATRICIA ANQUINETTE CUMMINGS LVN

Provider Business Mailing Address
First Line	:	6440 CLAIRE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-1316
Country	:	US
Telephone Number	:	817-306-2165
Fax Number	:	817-306-2165

Provider Business Practice Location Address
First Line	:	6440 CLAIRE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-1316
Country	:	US
Telephone Number	:	817-306-2165
Fax Number	:	817-306-2165

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

Provider Enumeration Date	:	09/15/2007
Last Update Date	:	09/15/2007

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