Provider Demographics
NPI:1992007405
Name:LOUIS, TONYA LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:LYNN
Last Name:LOUIS
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 1:2280 STATE ROUTE 179
Mailing Address - Street 2:
Mailing Address - City:JEROMESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44840-9609
Mailing Address - Country:US
Mailing Address - Phone:419-908-5694
Mailing Address - Fax:
Practice Address - Street 1:2280 STATE ROUTE 179
Practice Address - Street 2:
Practice Address - City:JEROMESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44840-9609
Practice Address - Country:US
Practice Address - Phone:419-908-5694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN126189-MIV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse