Provider Demographics
NPI:1073891693
Name:WEARS, TONYA M (LPN)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:M
Last Name:WEARS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8850 OLD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ROCK
Mailing Address - State:OH
Mailing Address - Zip Code:43720-9541
Mailing Address - Country:US
Mailing Address - Phone:740-408-3211
Mailing Address - Fax:
Practice Address - Street 1:8850 OLD RIVER RD
Practice Address - Street 2:
Practice Address - City:BLUE ROCK
Practice Address - State:OH
Practice Address - Zip Code:43720-9541
Practice Address - Country:US
Practice Address - Phone:740-408-3211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-31
Last Update Date:2011-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN108768164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse