Provider Demographics
NPI:1629403118
Name:WEBSTER, TINA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:BILLINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1323 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-3341
Mailing Address - Country:US
Mailing Address - Phone:419-569-4674
Mailing Address - Fax:
Practice Address - Street 1:1323 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-3341
Practice Address - Country:US
Practice Address - Phone:419-569-4674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.151420-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse