MEDICARE: MRS. DARLEEN BEATRICE ASHBAUGH

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	PN108380	OH

General Provider Information

NPI Number	:	1881750750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DARLEEN BEATRICE ASHBAUGH

Provider Business Mailing Address
First Line	:	315 BEECH AVE
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-1611
Country	:	US
Telephone Number	:	513-844-1357
Fax Number	:

Provider Business Practice Location Address
First Line	:	2930 BLUE ROCK RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239
Country	:	US
Telephone Number	:	513-245-1058
Fax Number	:

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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