Provider Demographics
NPI:1235389420
Name:TYUS, RONDA M (LPN)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:M
Last Name:TYUS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:RONDA
Other - Middle Name:M
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:655 HALEIGH WOODS CT
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-7150
Mailing Address - Country:US
Mailing Address - Phone:614-599-7524
Mailing Address - Fax:614-923-3903
Practice Address - Street 1:655 HALEIGH WOODS CT
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-7150
Practice Address - Country:US
Practice Address - Phone:614-599-7524
Practice Address - Fax:614-923-3903
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH110459164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse