Provider Demographics
NPI:1205010451
Name:BRENTLINGER, TAMMY RENEE
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:RENEE
Last Name:BRENTLINGER
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:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:OH
Mailing Address - Zip Code:45674-0355
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23 WEST STREET
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:OH
Practice Address - Zip Code:45674-0355
Practice Address - Country:US
Practice Address - Phone:740-245-5759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH111829164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse