MEDICARE: MRS. NANCY MUTHONI

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	376K00000X	Nurse's Aide	501128070606	OH

General Provider Information

NPI Number	:	1548604002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY MUTHONI

Provider Business Mailing Address
First Line	:	1690 FERRIS RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224
Country	:	US
Telephone Number	:	614-596-2899
Fax Number	:

Provider Business Practice Location Address
First Line	:	1690 FERRIS RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-5217
Country	:	US
Telephone Number	:	614-596-2899
Fax Number	:

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

Provider Enumeration Date	:	04/26/2013
Last Update Date	:	04/26/2013

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