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NPI Code Detail

MEDICARE: MRS. JESSICA MARIE HOSTETLER LPN

MEDICARE: MRS. JESSICA MARIE HOSTETLER 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
1164W00000XLicensed Practical NurseLPN.164074.MEDS-IVOH

General Provider Information

NPI Number : 1811650898
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JESSICA MARIE HOSTETLER LPN
Provider Business Mailing Address
First Line : 1552 N HONEYTOWN RD
Second Line :
City : WOOSTER
State : OH
Zip : 44691-9511
Country : US
Telephone Number : 330-264-0912
Fax Number : 330-263-4321
Provider Business Practice Location Address
First Line : 1552 N HONEYTOWN RD
Second Line :
City : WOOSTER
State : OH
Zip : 44691-9511
Country : US
Telephone Number : 330-264-0912
Fax Number : 330-263-4321
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2021
Last Update Date : 10/18/2021

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