MEDICARE: KATHLEEN ANN MEHL

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	LPN.078474.MEDS	OH

General Provider Information

NPI Number	:	1184189227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN ANN MEHL

Provider Business Mailing Address
First Line	:	10100 BAY CREEK RD
Second Line	:
City	:	ERIE
State	:	MI
Zip	:	48133-9304
Country	:	US
Telephone Number	:	734-625-7973
Fax Number	:

Provider Business Practice Location Address
First Line	:	10100 BAY CREEK RD
Second Line	:
City	:	ERIE
State	:	MI
Zip	:	48133-9304
Country	:	US
Telephone Number	:	734-625-7973
Fax Number	:

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

Provider Enumeration Date	:	02/03/2019
Last Update Date	:	02/03/2019

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Directions to “ KATHLEEN ANN MEHL ” Practice Location

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