Provider Demographics
NPI:1619681343
Name:ULM, TINA MARIE
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARIE
Last Name:ULM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 RIDGE AVE SE
Mailing Address - Street 2:
Mailing Address - City:EAST SPARTA
Mailing Address - State:OH
Mailing Address - Zip Code:44626-9454
Mailing Address - Country:US
Mailing Address - Phone:330-880-9702
Mailing Address - Fax:
Practice Address - Street 1:6300 RIDGE AVE SE
Practice Address - Street 2:
Practice Address - City:EAST SPARTA
Practice Address - State:OH
Practice Address - Zip Code:44626-9454
Practice Address - Country:US
Practice Address - Phone:330-880-9702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH72841570Medicaid
OH72841570Other72841570