MEDICARE: MRS. DOREEN LEA PYRTKO 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	PN 101000	OH

General Provider Information

NPI Number	:	1588998140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DOREEN LEA PYRTKO LPN

Provider Business Mailing Address
First Line	:	6853 TOBIK TRAIL
Second Line	:
City	:	PARMA HTS
State	:	OH
Zip	:	44130
Country	:	US
Telephone Number	:	440-345-5978
Fax Number	:

Provider Business Practice Location Address
First Line	:	6853 TOBIK TRL
Second Line	:
City	:	PARMA HEIGHTS
State	:	OH
Zip	:	44130-4514
Country	:	US
Telephone Number	:	440-345-5978
Fax Number	:

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

Provider Enumeration Date	:	09/29/2009
Last Update Date	:	09/29/2009

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