MEDICARE: MS. LORI ANN NICHOLSON 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	3747A0650X	Attendant Care Provider	PN 109321	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PN 109321	OTHER	OH	NURSING LICENSE

General Provider Information

NPI Number	:	1700805793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORI ANN NICHOLSON LPN

Provider Business Mailing Address
First Line	:	2585 HUBBARD RD
Second Line	:
City	:	MADISON
State	:	OH
Zip	:	44057-2527
Country	:	US
Telephone Number	:	440-796-4230
Fax Number	:

Provider Business Practice Location Address
First Line	:	2585 HUBBARD RD
Second Line	:
City	:	MADISON
State	:	OH
Zip	:	44057-2527
Country	:	US
Telephone Number	:	440-796-4230
Fax Number	:

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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