Provider Demographics
NPI:1437909124
Name:WHITE, TIA LENEE
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:LENEE
Last Name:WHITE
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 1:4461 MONTGOMERY RD NE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9767
Mailing Address - Country:US
Mailing Address - Phone:220-203-4121
Mailing Address - Fax:
Practice Address - Street 1:281 ELM DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-8944
Practice Address - Country:US
Practice Address - Phone:220-203-4121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide