MEDICARE: MS. ELIZABETH OLDHAM 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 121769	OH

General Provider Information

NPI Number	:	1407059116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH OLDHAM LPN

Provider Business Mailing Address
First Line	:	1541 E 191ST ST
Second Line	:	APT #626
City	:	EUCLID
State	:	OH
Zip	:	44117-1330
Country	:	US
Telephone Number	:	216-322-5790
Fax Number	:

Provider Business Practice Location Address
First Line	:	1541 E 191ST ST
Second Line	:	APT #626
City	:	EUCLID
State	:	OH
Zip	:	44117-1330
Country	:	US
Telephone Number	:	216-322-5790
Fax Number	:

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

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	11/18/2015

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