MEDICARE: MRS. DONNALYNN HOLIDAY LAVER 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	RN224375	OH

General Provider Information

NPI Number	:	1598911034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNALYNN HOLIDAY LAVER RN

Provider Business Mailing Address
First Line	:	2407 WIMBLEDON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-4332
Country	:	US
Telephone Number	:	614-581-8908
Fax Number	:	614-451-0869

Provider Business Practice Location Address
First Line	:	2407 WIMBLEDON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-4332
Country	:	US
Telephone Number	:	614-581-8908
Fax Number	:	614-451-0869

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

Provider Enumeration Date	:	08/15/2008
Last Update Date	:	08/15/2008

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