Provider Demographics
NPI:1013279025
Name:REUER, TIFFANY JEANETTE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:JEANETTE
Last Name:REUER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:JEANETTE
Other - Last Name:DOMINGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:396 S LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-7912
Mailing Address - Country:US
Mailing Address - Phone:419-564-7457
Mailing Address - Fax:
Practice Address - Street 1:396 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-7912
Practice Address - Country:US
Practice Address - Phone:419-564-7457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.132935-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse