MEDICARE: KACYNTHIA DERDEN 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	163WH0200X	Home Health Registered Nurse	163WH0200X	OH

General Provider Information

NPI Number	:	1760527121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KACYNTHIA DERDEN STNA

Provider Business Mailing Address
First Line	:	2017 BIGELOW ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-2135
Country	:	US
Telephone Number	:	419-244-3265
Fax Number	:	419-244-3265

Provider Business Practice Location Address
First Line	:	2017 BIGELOW ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-2135
Country	:	US
Telephone Number	:	419-244-3265
Fax Number	:	419-244-3265

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/08/2007

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Directions to “ KACYNTHIA DERDEN STNA” Practice Location

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