Provider Demographics
NPI:1497964613
Name:TOMLIN, ROSETTA M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ROSETTA
Middle Name:M
Last Name:TOMLIN
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 1:758 WINONA DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-1402
Mailing Address - Country:US
Mailing Address - Phone:330-782-5103
Mailing Address - Fax:
Practice Address - Street 1:814 SCHENLY AVE.
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-1402
Practice Address - Country:US
Practice Address - Phone:330-398-8667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH024500164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse