Provider Demographics
NPI:1851679930
Name:NETTLES, TAWONA LOVEONE I (LVN)
Entity Type:Individual
Prefix:MS
First Name:TAWONA
Middle Name:LOVEONE
Last Name:NETTLES
Suffix:I
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13738 CHARA AVE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-4879
Mailing Address - Country:US
Mailing Address - Phone:419-787-3653
Mailing Address - Fax:
Practice Address - Street 1:13738 CHARA AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-4879
Practice Address - Country:US
Practice Address - Phone:419-787-3653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-24
Last Update Date:2011-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 241493164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse