MEDICARE: MIRANDA KAY TRUMBULL 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	LPN.180355.MEDS-IV	OH

General Provider Information

NPI Number	:	1730979568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA KAY TRUMBULL LPN

Provider Business Mailing Address
First Line	:	2135 MELLWOOD CT
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43613-3407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2135 MELLWOOD CT
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43613-3407
Country	:	US
Telephone Number	:	419-466-9912
Fax Number	:

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

Provider Enumeration Date	:	05/06/2025
Last Update Date	:	05/06/2025

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