Provider Demographics
NPI:1124564414
Name:MARTIN, TYONIA (LPN-MED-IV)
Entity Type:Individual
Prefix:
First Name:TYONIA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPN-MED-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3594 CEDARBROOK RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3034
Mailing Address - Country:US
Mailing Address - Phone:216-527-4670
Mailing Address - Fax:
Practice Address - Street 1:3594 CEDARBROOK RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3034
Practice Address - Country:US
Practice Address - Phone:216-527-4670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH158086164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse