MEDICARE: DARLENE CARRIE ANNE YORK 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-145431-MEDS	OH
2	164W00000X	Licensed Practical Nurse	PN5213562	FL

General Provider Information

NPI Number	:	1629343553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARLENE CARRIE ANNE YORK LPN

Provider Business Mailing Address
First Line	:	17610 STATE ROUTE 136
Second Line	:
City	:	WINCHESTER
State	:	OH
Zip	:	45697-9422
Country	:	US
Telephone Number	:	937-690-9808
Fax Number	:

Provider Business Practice Location Address
First Line	:	3514 CURVING OAKS WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32820-2752
Country	:	US
Telephone Number	:	937-690-9115
Fax Number	:

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

Provider Enumeration Date	:	03/10/2012
Last Update Date	:	12/26/2013

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