Provider Demographics
NPI:1578507315
Name:LENTS, TINA L (RN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:L
Last Name:LENTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WEST 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:IL
Mailing Address - Zip Code:62863-1439
Mailing Address - Country:US
Mailing Address - Phone:618-263-3873
Mailing Address - Fax:618-262-4215
Practice Address - Street 1:130 WEST 7TH STREET
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:IL
Practice Address - Zip Code:62863-1439
Practice Address - Country:US
Practice Address - Phone:618-263-3873
Practice Address - Fax:618-262-4215
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041335979163W00000X
IN28164972A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse