MEDICARE: MS. LENORE RUTH POSEDLY CNP

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	261QA1903X	Ambulatory Surgical Clinic/Center	COA110972	OH
2	363LA2200X	Adult Health Nurse Practitioner	NP02818	OH

General Provider Information

NPI Number	:	1922194414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LENORE RUTH POSEDLY CNP

Provider Business Mailing Address
First Line	:	1180 W GARFIELD RD
Second Line	:
City	:	AURORA
State	:	OH
Zip	:	44202-7519
Country	:	US
Telephone Number	:	330-541-6779
Fax Number	:	330-562-8755

Provider Business Practice Location Address
First Line	:	14121 PARKE LONG CT
Second Line	:	SUITE 201
City	:	CHANTILLY
State	:	VA
Zip	:	20151-1647
Country	:	US
Telephone Number	:	571-512-7287
Fax Number	:	800-752-2471

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/17/2015

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