Provider Demographics
NPI:1205656170
Name:TONKOVICH, SHAE REA
Entity type:Individual
Prefix:
First Name:SHAE
Middle Name:REA
Last Name:TONKOVICH
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 1:3779 PITT ST
Mailing Address - Street 2:
Mailing Address - City:SCHELLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15559-9040
Mailing Address - Country:US
Mailing Address - Phone:304-680-3411
Mailing Address - Fax:
Practice Address - Street 1:9707 LINCOLN HIGHWAY
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-3717
Practice Address - Country:US
Practice Address - Phone:814-652-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN795598163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse