MEDICARE: MRS. CAROLINE LUCY HOLBROOK 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	PN096801	OH

General Provider Information

NPI Number	:	1417912312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLINE LUCY HOLBROOK LPN

Provider Business Mailing Address
First Line	:	PO BOX 1120
Second Line	:
City	:	ASHTABULA
State	:	OH
Zip	:	44005-1120
Country	:	US
Telephone Number	:	440-344-4579
Fax Number	:	440-224-0916

Provider Business Practice Location Address
First Line	:	4321 NORTH MONROE CTR RD
Second Line	:
City	:	KINGSVILLE
State	:	OH
Zip	:	44048
Country	:	US
Telephone Number	:	440-224-0130
Fax Number	:	440-224-0916

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	07/09/2007

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