MEDICARE: MS. ROXANNE LEE IRICK 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	RN253243	OH

General Provider Information

NPI Number	:	1598949091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROXANNE LEE IRICK RN

Provider Business Mailing Address
First Line	:	1893 QUEENS MEADOW LN
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-1266
Country	:	US
Telephone Number	:	614-301-8193
Fax Number	:

Provider Business Practice Location Address
First Line	:	1893 QUEENS MEADOW LN
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-1266
Country	:	US
Telephone Number	:	614-301-8193
Fax Number	:

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

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	12/20/2007

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