Provider Demographics
NPI:1790246742
Name:TOMPKINS, LADONNA MICHELLE
Entity Type:Individual
Prefix:
First Name:LADONNA
Middle Name:MICHELLE
Last Name:TOMPKINS
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 1:6665 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:NEW FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44216-9464
Mailing Address - Country:US
Mailing Address - Phone:330-391-6284
Mailing Address - Fax:
Practice Address - Street 1:6665 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:NEW FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:44216-9464
Practice Address - Country:US
Practice Address - Phone:330-329-0913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-30
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001190175T00000X
OHLPN.103346.MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH001190Medicaid