MEDICARE: ANGELA WAHL 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. 108950-MEDS	OH

General Provider Information

NPI Number	:	1447565999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA WAHL LPN

Provider Business Mailing Address
First Line	:	318 NORTH ST
Second Line	:	PO BOX 46
City	:	DUNCAN FALLS
State	:	OH
Zip	:	43734-0046
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	318 NORTH ST
Second Line	:
City	:	DUNCAN FALLS
State	:	OH
Zip	:	43734-9762
Country	:	US
Telephone Number	:	740-617-9471
Fax Number	:

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

Provider Enumeration Date	:	08/09/2010
Last Update Date	:	08/09/2010

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