MEDICARE: NYARADZAI BIANCA JASON 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	126094IV	OH

General Provider Information

NPI Number	:	1972081479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NYARADZAI BIANCA JASON LPN

Provider Business Mailing Address
First Line	:	5552 LITTLE FLOWER AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-6808
Country	:	US
Telephone Number	:	513-919-9956
Fax Number	:

Provider Business Practice Location Address
First Line	:	5552 LITTLE FLOWER AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-6808
Country	:	US
Telephone Number	:	513-919-9956
Fax Number	:

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

Provider Enumeration Date	:	08/06/2018
Last Update Date	:	08/06/2018

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