MEDICARE: MRS. KELLY RENEE GUINN RN

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	163W00000X	Registered Nurse	175115	OH

General Provider Information

NPI Number	:	1578814208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY RENEE GUINN RN

Provider Business Mailing Address
First Line	:	7662 COOK RD
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-8065
Country	:	US
Telephone Number	:	614-561-2557
Fax Number	:

Provider Business Practice Location Address
First Line	:	7662 COOK RD
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-8065
Country	:	US
Telephone Number	:	614-561-2557
Fax Number	:

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

Provider Enumeration Date	:	09/20/2012
Last Update Date	:	09/20/2012

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