Provider Demographics
NPI:1508824426
Name:REED, TINA MARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIE
Last Name:REED
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 1:6342 WHIMS ROAD
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110
Mailing Address - Country:US
Mailing Address - Phone:614-571-7037
Mailing Address - Fax:
Practice Address - Street 1:6342 WHIMS ROAD
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110
Practice Address - Country:US
Practice Address - Phone:614-571-7037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-090384164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH105002137599Medicaid