MEDICARE: ALICIA MARIE MEDINA

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	PN-131616	OH

General Provider Information

NPI Number	:	1265767511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA MARIE MEDINA

Provider Business Mailing Address
First Line	:	130 CURTIS DRIVE
Second Line	:
City	:	NORTH LEWISBURG
State	:	OH
Zip	:	43060
Country	:	US
Telephone Number	:	614-301-4533
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 CURTIS ST
Second Line	:
City	:	NORTH LEWISBURG
State	:	OH
Zip	:	43060-9751
Country	:	US
Telephone Number	:	614-301-4533
Fax Number	:

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

Provider Enumeration Date	:	10/05/2009
Last Update Date	:	10/05/2009

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Directions to “ ALICIA MARIE MEDINA ” Practice Location

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