Provider Demographics
NPI:1134622988
Name:HOWARD, TIAWAN RYAN (LPN)
Entity type:Individual
Prefix:MR
First Name:TIAWAN
Middle Name:RYAN
Last Name:HOWARD
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 1:189 EMERALD LN
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1400
Mailing Address - Country:US
Mailing Address - Phone:440-212-8018
Mailing Address - Fax:
Practice Address - Street 1:189 EMERALD LN
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1400
Practice Address - Country:US
Practice Address - Phone:440-212-8018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH129460.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse