Provider Demographics
NPI:1043088073
Name:FRY, TANAEA ELAINE (LPN, #147093)
Entity Type:Individual
Prefix:
First Name:TANAEA
Middle Name:ELAINE
Last Name:FRY
Suffix:
Gender:F
Credentials:LPN, #147093
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 ANTLES AVE
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-2313
Mailing Address - Country:US
Mailing Address - Phone:614-353-1187
Mailing Address - Fax:
Practice Address - Street 1:68 ANTLES AVE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-2313
Practice Address - Country:US
Practice Address - Phone:330-217-4810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH147093164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse