Provider Demographics
NPI:1558664672
Name:HILL, TAMARA ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:ANN
Last Name:HILL
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 1:241 VINE ST
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:OH
Mailing Address - Zip Code:43410-1529
Mailing Address - Country:US
Mailing Address - Phone:419-603-0524
Mailing Address - Fax:
Practice Address - Street 1:241 VINE ST
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:OH
Practice Address - Zip Code:43410-1529
Practice Address - Country:US
Practice Address - Phone:419-603-0524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-11
Last Update Date:2010-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH164WOOOOOX164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse