MEDICARE: JERINA DAWN HANCOX 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	168060	OH

General Provider Information

NPI Number	:	1639773740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERINA DAWN HANCOX LPN

Provider Business Mailing Address
First Line	:	869 N JENKINS BLVD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44306-3767
Country	:	US
Telephone Number	:	330-313-6726
Fax Number	:

Provider Business Practice Location Address
First Line	:	869 N JENKINS BLVD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44306-3767
Country	:	US
Telephone Number	:	330-313-6726
Fax Number	:

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

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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