Provider Demographics
NPI:1265662142
Name:DANIELS, TANA LEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TANA
Middle Name:LEE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:TANA
Other - Middle Name:LEE
Other - Last Name:THERRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:264 STATE ROUTE 604
Mailing Address - Street 2:
Mailing Address - City:POLK
Mailing Address - State:OH
Mailing Address - Zip Code:44866-9722
Mailing Address - Country:US
Mailing Address - Phone:419-869-7217
Mailing Address - Fax:
Practice Address - Street 1:264 STATE ROUTE 604
Practice Address - Street 2:
Practice Address - City:POLK
Practice Address - State:OH
Practice Address - Zip Code:44866-9722
Practice Address - Country:US
Practice Address - Phone:419-869-7217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-25
Last Update Date:2009-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 130015164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse