MEDICARE: MRS. BETTY JEAN TRANCHIDA 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	2209786	OH

General Provider Information

NPI Number	:	1558378604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETTY JEAN TRANCHIDA LPN

Provider Business Mailing Address
First Line	:	PO BOX 404
Second Line	:
City	:	AUSTINBURG
State	:	OH
Zip	:	44010-0404
Country	:	US
Telephone Number	:	440-275-1827
Fax Number	:

Provider Business Practice Location Address
First Line	:	2280 RT 307
Second Line	:
City	:	AUSTINBURG
State	:	OH
Zip	:	44010
Country	:	US
Telephone Number	:	440-275-1827
Fax Number	:

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/08/2007

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