Provider Demographics
NPI:1649508862
Name:O'CLAIRE, TONYA MADISON (RN)
Entity type:Individual
Prefix:MS
First Name:TONYA
Middle Name:MADISON
Last Name:O'CLAIRE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14790 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:GUERNEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95446-9320
Mailing Address - Country:US
Mailing Address - Phone:707-869-0395
Mailing Address - Fax:
Practice Address - Street 1:14790 CHERRY ST
Practice Address - Street 2:
Practice Address - City:GUERNEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95446-9320
Practice Address - Country:US
Practice Address - Phone:707-869-0395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-29
Last Update Date:2009-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA278663163WC0400X, 163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WC0400XNursing Service ProvidersRegistered NurseCase Management