Provider Demographics
NPI:1659647659
Name:DETLING, TIA NOEL
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:NOEL
Last Name:DETLING
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 1:215 BELVIEW ST
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43713-1009
Mailing Address - Country:US
Mailing Address - Phone:740-238-1645
Mailing Address - Fax:
Practice Address - Street 1:215 BELVIEW ST
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43713-1009
Practice Address - Country:US
Practice Address - Phone:740-238-1645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-24
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 147233164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse