Provider Demographics
NPI:1639997091
Name:BROWN, TYNISHA SHAUNTEL
Entity type:Individual
Prefix:
First Name:TYNISHA
Middle Name:SHAUNTEL
Last Name:BROWN
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 1:520 W EUREKA ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4738
Mailing Address - Country:US
Mailing Address - Phone:419-302-6409
Mailing Address - Fax:
Practice Address - Street 1:520 W EUREKA ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4738
Practice Address - Country:US
Practice Address - Phone:419-302-6409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRE791080347E00000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No347E00000XTransportation ServicesTransportation Broker