MEDICARE: ROCKWELL CITY LYTTON SCHOOL DISTRICT

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	097435	IA
2	251300000X	Local Education Agency (LEA)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649323429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKWELL CITY LYTTON SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	1000 TONAWANDA AVE
Second Line	:
City	:	ROCKWELL CITY
State	:	IA
Zip	:	50579
Country	:	US
Telephone Number	:	712-297-7341
Fax Number	:	712-297-7320

Provider Business Practice Location Address
First Line	:	1000 TONAWANDA AVE
Second Line	:	ROCKWELL CITY LYTTON HIGH SCHOOL
City	:	ROCKWELL CITY
State	:	IA
Zip	:	50579
Country	:	US
Telephone Number	:	712-297-7341
Fax Number	:	712-297-7320

Authorized Official
Title or Position	:	SCHOOL NURSE REGISTERED NURSE
Name	:	MR. ROBERT LEE ERICSSON
Credential	:	REGISTERED NURSE
Telephone Number	:	712-297-7341

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	09/19/2012

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Directions to “ROCKWELL CITY LYTTON SCHOOL DISTRICT ” Practice Location

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