Provider Demographics
NPI:1871180240
Name:TICE, TONIA SUE
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:SUE
Last Name:TICE
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 1:3825 N LICKERT HARDER RD
Mailing Address - Street 2:
Mailing Address - City:GRAYTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43432-9721
Mailing Address - Country:US
Mailing Address - Phone:419-262-6948
Mailing Address - Fax:
Practice Address - Street 1:3825 N LICKERT HARDER RD
Practice Address - Street 2:
Practice Address - City:GRAYTOWN
Practice Address - State:OH
Practice Address - Zip Code:43432-9721
Practice Address - Country:US
Practice Address - Phone:419-262-6948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker