Provider Demographics
NPI:1073116281
Name:LIGON, TANYA E
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:E
Last Name:LIGON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TANYA
Other - Middle Name:E
Other - Last Name:LIGON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18400 HAZELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-3535
Mailing Address - Country:US
Mailing Address - Phone:216-315-7046
Mailing Address - Fax:
Practice Address - Street 1:18400 HAZELWOOD AVE
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3535
Practice Address - Country:US
Practice Address - Phone:216-315-7046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH37782641298376K00000X
376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1831487Medicaid