Provider Demographics
NPI:1700092368
Name:NIELAND, TINA J (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:J
Last Name:NIELAND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2341 HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:TAMA
Mailing Address - State:IA
Mailing Address - Zip Code:52339-9774
Mailing Address - Country:US
Mailing Address - Phone:641-484-3519
Mailing Address - Fax:
Practice Address - Street 1:307 MESKWAKI RD
Practice Address - Street 2:
Practice Address - City:TAMA
Practice Address - State:IA
Practice Address - Zip Code:52339-9634
Practice Address - Country:US
Practice Address - Phone:641-484-4094
Practice Address - Fax:641-484-2432
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP12716164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse