MEDICARE: MS. BRENDA NOHEMI MEDELLIN 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	PN145868	OH

General Provider Information

NPI Number	:	1952687550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRENDA NOHEMI MEDELLIN LPN

Provider Business Mailing Address
First Line	:	1016 CURTIS ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43609-2308
Country	:	US
Telephone Number	:	419-255-3057
Fax Number	:

Provider Business Practice Location Address
First Line	:	2760 AIRPORT DR
Second Line	:	130
City	:	COLUMBUS
State	:	OH
Zip	:	43219-2284
Country	:	US
Telephone Number	:	614-751-7777
Fax Number	:

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

Provider Enumeration Date	:	10/26/2011
Last Update Date	:	10/26/2011

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