Provider Demographics
NPI:1194002105
Name:ATWOOD, TIA MARIA (LPN)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:MARIA
Last Name:ATWOOD
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 1:237 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-6455
Mailing Address - Country:US
Mailing Address - Phone:315-372-1647
Mailing Address - Fax:
Practice Address - Street 1:5825 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NY
Practice Address - Zip Code:13078-9575
Practice Address - Country:US
Practice Address - Phone:315-534-4947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298668-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse