MEDICARE: MRS. PAMELA LYNN PRICE 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	163WC1500X	Community Health Registered Nurse	RN.239156	OH

General Provider Information

NPI Number	:	1649878943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAMELA LYNN PRICE RN

Provider Business Mailing Address
First Line	:	126 HARRIS AVE
Second Line	:
City	:	BETHEL
State	:	OH
Zip	:	45106-8313
Country	:	US
Telephone Number	:	513-260-3594
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 MEARS AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-1908
Country	:	US
Telephone Number	:	513-363-3821
Fax Number	:

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

Provider Enumeration Date	:	10/09/2020
Last Update Date	:	10/09/2020

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