Provider Demographics
NPI:1679129209
Name:LIST, TINA MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARIE
Last Name:LIST
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24651 280TH ST.
Mailing Address - Street 2:
Mailing Address - City:WAUCOMA
Mailing Address - State:IA
Mailing Address - Zip Code:52171
Mailing Address - Country:US
Mailing Address - Phone:563-776-9541
Mailing Address - Fax:
Practice Address - Street 1:24651 280TH ST.
Practice Address - Street 2:
Practice Address - City:WAUCOMA
Practice Address - State:IA
Practice Address - Zip Code:52171
Practice Address - Country:US
Practice Address - Phone:563-776-9541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider