MEDICARE: HEATHER RENEE MAST 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	PN 136647-M-IV	OH

General Provider Information

NPI Number	:	1326361312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER RENEE MAST LPN

Provider Business Mailing Address
First Line	:	4870 STATE ROUTE 37 W
Second Line	:
City	:	JUNCTION CITY
State	:	OH
Zip	:	43748-9716
Country	:	US
Telephone Number	:	740-503-2633
Fax Number	:

Provider Business Practice Location Address
First Line	:	4870 STATE ROUTE 37 W
Second Line	:
City	:	JUNCTION CITY
State	:	OH
Zip	:	43748-9716
Country	:	US
Telephone Number	:	740-503-2633
Fax Number	:

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

Provider Enumeration Date	:	03/05/2010
Last Update Date	:	03/05/2010

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Directions to “ HEATHER RENEE MAST LPN” Practice Location

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