MEDICARE: RASHELL JEANNINE KITTS 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	135871-IV	OH

General Provider Information

NPI Number	:	1356611701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RASHELL JEANNINE KITTS LPN

Provider Business Mailing Address
First Line	:	4316 LONG LAKE DR
Second Line	:	APT 5210
City	:	BATAVIA
State	:	OH
Zip	:	45103-4480
Country	:	US
Telephone Number	:	740-876-2898
Fax Number	:

Provider Business Practice Location Address
First Line	:	4316 LONG LAKE DR
Second Line	:	APT 5210
City	:	BATAVIA
State	:	OH
Zip	:	45103-4480
Country	:	US
Telephone Number	:	740-876-2898
Fax Number	:

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

Provider Enumeration Date	:	01/03/2012
Last Update Date	:	01/03/2012

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