Provider Demographics
NPI:1114146727
Name:MYERS, MARILYN JOE (LPN LICENSE)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:JOE
Last Name:MYERS
Suffix:
Gender:F
Credentials:LPN LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6338 BRUSH LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LEWISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43060-9621
Mailing Address - Country:US
Mailing Address - Phone:937-747-3706
Mailing Address - Fax:
Practice Address - Street 1:6338 BRUSH LAKE RD
Practice Address - Street 2:
Practice Address - City:NORTH LEWISBURG
Practice Address - State:OH
Practice Address - Zip Code:43060-9621
Practice Address - Country:US
Practice Address - Phone:937-747-3706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.117346374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel