Provider Demographics
NPI:1225415334
Name:WARE, TONYA MARIE
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:MARIE
Last Name:WARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3039 SOLAR DR NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-1611
Mailing Address - Country:US
Mailing Address - Phone:330-883-3537
Mailing Address - Fax:
Practice Address - Street 1:3039 SOLAR DR NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-1611
Practice Address - Country:US
Practice Address - Phone:330-883-3537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0053360Medicaid