MEDICARE: MRS. BRANDY MICHELLE POLLITT L.P.N.

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	P.N. 120395	OH

General Provider Information

NPI Number	:	1568724060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRANDY MICHELLE POLLITT L.P.N.

Provider Business Mailing Address
First Line	:	260 W MAIN ST
Second Line	:
City	:	RUSSELLVILLE
State	:	OH
Zip	:	45168-8730
Country	:	US
Telephone Number	:	937-515-8308
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 W MAIN ST
Second Line	:
City	:	RUSSELLVILLE
State	:	OH
Zip	:	45168-8730
Country	:	US
Telephone Number	:	937-515-8308
Fax Number	:

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

Provider Enumeration Date	:	06/11/2012
Last Update Date	:	06/11/2012

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