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NPI Code Detail

MEDICARE: LAURA MARIE FANGMAN RN

MEDICARE: LAURA MARIE FANGMAN RN
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
1163W00000XRegistered Nurse330565OH

General Provider Information

NPI Number : 1437797321
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA MARIE FANGMAN RN
Provider Business Mailing Address
First Line : 2136 W 8TH ST OFC
Second Line :
City : CINCINNATI
State : OH
Zip : 45204-2052
Country : US
Telephone Number : 513-357-2809
Fax Number :
Provider Business Practice Location Address
First Line : 2411 BALTIMORE AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45225-1001
Country : US
Telephone Number : 513-363-4118
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2019
Last Update Date : 12/11/2019

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