Provider Demographics
NPI:1700525102
Name:LANDERS, TONI COLUMBIA
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:COLUMBIA
Last Name:LANDERS
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 1:310 EAST AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-5746
Mailing Address - Country:US
Mailing Address - Phone:216-413-9578
Mailing Address - Fax:
Practice Address - Street 1:310 EAST AVE APT 306
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-5746
Practice Address - Country:US
Practice Address - Phone:216-413-9578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant