MEDICARE: MISS ESTEE LAUDER HOUSTON STNA

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	376K00000X	Nurse's Aide	401331441211	OH

General Provider Information

NPI Number	:	1720358468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ESTEE LAUDER HOUSTON STNA

Provider Business Mailing Address
First Line	:	2438 HOLLYWOOD AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43620-1040
Country	:	US
Telephone Number	:	419-699-2816
Fax Number	:

Provider Business Practice Location Address
First Line	:	2438 HOLLYWOOD AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43620-1040
Country	:	US
Telephone Number	:	419-699-2816
Fax Number	:

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

Provider Enumeration Date	:	01/11/2012
Last Update Date	:	01/11/2012

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Directions to “ MISS ESTEE LAUDER HOUSTON STNA” Practice Location

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