Provider Demographics
NPI:1609282730
Name:VANBUSKIRK, TONYA (HOME HEALTH AID)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:VANBUSKIRK
Suffix:
Gender:F
Credentials:HOME HEALTH AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 N IDA ST
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-1023
Mailing Address - Country:US
Mailing Address - Phone:567-674-3681
Mailing Address - Fax:
Practice Address - Street 1:406 N IDA ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-1023
Practice Address - Country:US
Practice Address - Phone:567-674-3681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3069996Medicaid