MEDICARE: MS. VICKEY YVONNE ALLEN 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	PN115412	OH
2	372600000X	Adult Companion	PN115412	OH
3	374U00000X	Home Health Aide	PN115412	OH
4	376J00000X	Homemaker	PN115412	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PN115412	OTHER	OH	OHIO BOARD OF NURSING

General Provider Information

NPI Number	:	1659736205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICKEY YVONNE ALLEN LPN

Provider Business Mailing Address
First Line	:	1739 DALEWOOD PL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-5715
Country	:	US
Telephone Number	:	513-908-1851
Fax Number	:

Provider Business Practice Location Address
First Line	:	1739 DALEWOOD PL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237
Country	:	US
Telephone Number	:	513-908-1851
Fax Number	:

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

Provider Enumeration Date	:	12/28/2015
Last Update Date	:	12/28/2015

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