Provider Demographics
NPI:1225280811
Name:RIOS, TINA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:RIOS
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 1:3202 STONECREEK DR APT 2
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-5270
Mailing Address - Country:US
Mailing Address - Phone:608-279-6518
Mailing Address - Fax:
Practice Address - Street 1:3202 STONECREEK DR APT 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-5270
Practice Address - Country:US
Practice Address - Phone:608-279-6518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI305581-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38336500Medicaid