MEDICARE: MRS. JANICE LOURENE WOODWARD 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	039125	OH

General Provider Information

NPI Number	:	1619102340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANICE LOURENE WOODWARD LPN

Provider Business Mailing Address
First Line	:	3195 GORSUCH RD
Second Line	:
City	:	NASHPORT
State	:	OH
Zip	:	43830-9742
Country	:	US
Telephone Number	:	740-452-6077
Fax Number	:

Provider Business Practice Location Address
First Line	:	3195 GORSUCH RD
Second Line	:
City	:	NASHPORT
State	:	OH
Zip	:	43830-9742
Country	:	US
Telephone Number	:	740-452-6077
Fax Number	:

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

Provider Enumeration Date	:	05/26/2009
Last Update Date	:	09/01/2009

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