MEDICARE: HEATHER DAWN LANIGAN 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	PN 105709	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790832350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER DAWN LANIGAN L.P.N.

Provider Business Mailing Address
First Line	:	7079 COLUMBUS RD.
Second Line	:
City	:	MOUNT LIBERTY
State	:	OH
Zip	:	43048
Country	:	US
Telephone Number	:	740-625-4049
Fax Number	:

Provider Business Practice Location Address
First Line	:	7079 COLUMBUS RD.
Second Line	:
City	:	MOUNT LIBERTY
State	:	OH
Zip	:	43048
Country	:	US
Telephone Number	:	740-625-4049
Fax Number	:

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	07/09/2007

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