MEDICARE: MRS. JUEL LYNN NEWSOM STNA

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	171WH0202X	Home Modifications Contractor

General Provider Information

NPI Number	:	1427328582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUEL LYNN NEWSOM STNA

Provider Business Mailing Address
First Line	:	2018 BARROWS ST.
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43613
Country	:	US
Telephone Number	:	419-514-8175
Fax Number	:

Provider Business Practice Location Address
First Line	:	2018 BARROWS ST.
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43613
Country	:	US
Telephone Number	:	419-514-8175
Fax Number	:

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

Provider Enumeration Date	:	01/06/2012
Last Update Date	:	01/06/2012

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