MEDICARE: MS. LADEYA LYNN NORTH 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	133161	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	:	1194958181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LADEYA LYNN NORTH LPN

Provider Business Mailing Address
First Line	:	6408 CLEMATIS DR
Second Line	:
City	:	WEST CARROLLTON
State	:	OH
Zip	:	45449-3012
Country	:	US
Telephone Number	:	937-313-3805
Fax Number	:	937-436-0899

Provider Business Practice Location Address
First Line	:	6408 CLEMATIS DR
Second Line	:
City	:	WEST CARROLLTON
State	:	OH
Zip	:	45449-3012
Country	:	US
Telephone Number	:	937-313-3805
Fax Number	:	937-436-0899

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

Provider Enumeration Date	:	08/25/2009
Last Update Date	:	08/28/2013

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