Provider Demographics
NPI:1013165885
Name:TIPTON, STONEY G (LPN)
Entity Type:Individual
Prefix:
First Name:STONEY
Middle Name:G
Last Name:TIPTON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6231 E NEW MARKET RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-7721
Mailing Address - Country:US
Mailing Address - Phone:937-840-9926
Mailing Address - Fax:
Practice Address - Street 1:6231 E NEW MARKET RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-7721
Practice Address - Country:US
Practice Address - Phone:937-840-9926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN120252164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse