MEDICARE: MRS. ROSE MARIE TAYLOR 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	081382	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2262831	OTHER	OH	IP OHIO DEPT OF JOB & FAM

General Provider Information

NPI Number	:	1194888511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROSE MARIE TAYLOR LPN

Provider Business Mailing Address
First Line	:	52530 OLD INFIRMARY ROAD
Second Line	:
City	:	PLEASANT CITY
State	:	OH
Zip	:	43772-9619
Country	:	US
Telephone Number	:	740-732-7151
Fax Number	:	740-732-2502

Provider Business Practice Location Address
First Line	:	52530 OLD INFIRMARY ROAD
Second Line	:
City	:	PLEASANT CITY
State	:	OH
Zip	:	43772-9619
Country	:	US
Telephone Number	:	740-732-7151
Fax Number	:	740-732-2502

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	07/08/2007

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