MEDICARE: MISS TERRIKA RENEA MARR 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	140002	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	140002	OTHER	OH	OHIO BOARD OF NURSING

General Provider Information

NPI Number	:	1306159736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TERRIKA RENEA MARR LPN

Provider Business Mailing Address
First Line	:	4334 TRUXTON PLACE DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-5438
Country	:	US
Telephone Number	:	419-514-5386
Fax Number	:

Provider Business Practice Location Address
First Line	:	4334 TRUXTON PLACE DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-5438
Country	:	US
Telephone Number	:	419-514-5386
Fax Number	:

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

Provider Enumeration Date	:	07/14/2010
Last Update Date	:	07/14/2010

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