MEDICARE: JANET BAHLE CNS

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	364SC0200X	Critical Care Medicine Clinical Nurse Specialist	NS-00411	OH

General Provider Information

NPI Number	:	1477999134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET BAHLE CNS

Provider Business Mailing Address
First Line	:	PO BOX 30716
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44130-0716
Country	:	US
Telephone Number	:	440-879-0084
Fax Number	:	440-879-0084

Provider Business Practice Location Address
First Line	:	6847 N CHESTNUT ST
Second Line	:
City	:	RAVENNA
State	:	OH
Zip	:	44266-3929
Country	:	US
Telephone Number	:	330-297-0811
Fax Number	:

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

Provider Enumeration Date	:	05/21/2013
Last Update Date	:	05/21/2013

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