MEDICARE: MR. CHESTER J SIAFA 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	PN.125031	OH

General Provider Information

NPI Number	:	1821262221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHESTER J SIAFA LPN

Provider Business Mailing Address
First Line	:	2062 BRIDLINGTON LN APT F
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-3851
Country	:	US
Telephone Number	:	617-888-0153
Fax Number	:

Provider Business Practice Location Address
First Line	:	2062 BRIDLINGTON LN APT F
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-3851
Country	:	US
Telephone Number	:	617-888-0153
Fax Number	:

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

Provider Enumeration Date	:	04/16/2008
Last Update Date	:	04/16/2008

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