MEDICARE: MR. DSCHON LAMAR POWELL NURSE AID

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	374U00000X	Home Health Aide		OH

General Provider Information

NPI Number	:	1528243227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DSCHON LAMAR POWELL NURSE AID

Provider Business Mailing Address
First Line	:	3137 MCGILL RD
Second Line	:	3137 MCGILL LANE
City	:	CINCINNATI
State	:	OH
Zip	:	45251-3111
Country	:	US
Telephone Number	:	513-522-1390
Fax Number	:	513-522-1390

Provider Business Practice Location Address
First Line	:	3137 MCGILL RD
Second Line	:	3137 MCGILL LANE
City	:	CINCINNATI
State	:	OH
Zip	:	45251-3111
Country	:	US
Telephone Number	:	513-522-1390
Fax Number	:	513-522-1390

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

Provider Enumeration Date	:	01/01/2008
Last Update Date	:	01/01/2008

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