MEDICARE: ROBERT B GILLESPIE L.P.N.

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	P.N.151275	OH

General Provider Information

NPI Number	:	1730625567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT B GILLESPIE L.P.N.

Provider Business Mailing Address
First Line	:	347 MANN AVE
Second Line	:
City	:	FAIRBORN
State	:	OH
Zip	:	45324-5152
Country	:	US
Telephone Number	:	937-234-3766
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 PARKLAWN DR
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45440-1251
Country	:	US
Telephone Number	:	937-499-1780
Fax Number	:

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

Provider Enumeration Date	:	01/18/2017
Last Update Date	:	01/18/2017

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