Provider Demographics
NPI:1164637260
Name:HEAL, TAMMY LEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LEE
Last Name:HEAL
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 1:11228 EAST COUNTY ROAD 6
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:OH
Mailing Address - Zip Code:44807-0192
Mailing Address - Country:US
Mailing Address - Phone:419-426-5265
Mailing Address - Fax:
Practice Address - Street 1:11228 EAST COUNTY ROAD 6
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:OH
Practice Address - Zip Code:44807-0192
Practice Address - Country:US
Practice Address - Phone:419-426-5265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 123308 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2708672Medicaid