MEDICARE: SHIRLEY JEAN DUNCAN

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1669089959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY JEAN DUNCAN

Provider Business Mailing Address
First Line	:	3213 RALEIGH DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-1855
Country	:	US
Telephone Number	:	567-698-3246
Fax Number	:

Provider Business Practice Location Address
First Line	:	3213 RALEIGH DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-1855
Country	:	US
Telephone Number	:	567-698-3246
Fax Number	:

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

Provider Enumeration Date	:	09/30/2020
Last Update Date	:	09/30/2020

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Directions to “ SHIRLEY JEAN DUNCAN ” Practice Location

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