MEDICARE: MRS. CARMELLA COLSTON USHER 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 062952	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	:	1821279555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARMELLA COLSTON USHER L.P.N.

Provider Business Mailing Address
First Line	:	PO BOX 18981
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-0981
Country	:	US
Telephone Number	:	216-262-5176
Fax Number	:	216-381-9796

Provider Business Practice Location Address
First Line	:	1042 HILLSTONE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-2426
Country	:	US
Telephone Number	:	216-291-5363
Fax Number	:

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

Provider Enumeration Date	:	11/22/2007
Last Update Date	:	11/22/2007

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