MEDICARE: MRS. ELLA LOUISE ALLEN

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	3747A0650X	Attendant Care Provider	RT300439	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487914917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELLA LOUISE ALLEN

Provider Business Mailing Address
First Line	:	774 BRICE AVE
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45801-3914
Country	:	US
Telephone Number	:	419-228-5663
Fax Number	:

Provider Business Practice Location Address
First Line	:	774 BRICE AVE
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45801-3914
Country	:	US
Telephone Number	:	419-228-5663
Fax Number	:

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

Provider Enumeration Date	:	05/17/2012
Last Update Date	:	05/17/2012

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