MEDICARE: LATASHA S HEISEL RN

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	163W00000X	Registered Nurse	366903	OH

General Provider Information

NPI Number	:	1861839789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATASHA S HEISEL RN

Provider Business Mailing Address
First Line	:	6402 WITHERBY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-1852
Country	:	US
Telephone Number	:	513-602-6092
Fax Number	:

Provider Business Practice Location Address
First Line	:	6402 WITHERBY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-1852
Country	:	US
Telephone Number	:	513-602-6092
Fax Number	:

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

Provider Enumeration Date	:	06/01/2013
Last Update Date	:	06/01/2013

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