MEDICARE: KIMBERLY MCGREW

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.128603-M-IV	OH

General Provider Information

NPI Number	:	1952721474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY MCGREW

Provider Business Mailing Address
First Line	:	4212 MYRTLE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-2410
Country	:	US
Telephone Number	:	513-264-7800
Fax Number	:

Provider Business Practice Location Address
First Line	:	8073 TYLERSVILLE RD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-2589
Country	:	US
Telephone Number	:	513-777-1400
Fax Number	:

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

Provider Enumeration Date	:	04/23/2014
Last Update Date	:	04/23/2014

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