Provider Demographics
NPI:1417330077
Name:CRONN, TINA MARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIE
Last Name:CRONN
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 1:413 S YELLOWSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1042
Mailing Address - Country:US
Mailing Address - Phone:608-277-1010
Mailing Address - Fax:
Practice Address - Street 1:413 S YELLOWSTONE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1042
Practice Address - Country:US
Practice Address - Phone:608-277-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI319153164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse