Provider Demographics
NPI:1306183959
Name:TIDERMAN, JESSICA (DEM)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:TIDERMAN
Suffix:
Gender:F
Credentials:DEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:HAMLER
Mailing Address - State:OH
Mailing Address - Zip Code:43524-0091
Mailing Address - Country:US
Mailing Address - Phone:567-868-3311
Mailing Address - Fax:
Practice Address - Street 1:1655 TIFFIN AVE STE B3
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-6848
Practice Address - Country:US
Practice Address - Phone:567-868-3311
Practice Address - Fax:567-316-6425
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay
No374J00000XNursing Service Related ProvidersDoula