Provider Demographics
NPI:1770781981
Name:RODGERS, TANYA MARIE (LPN)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:MARIE
Last Name:RODGERS
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 1:246 NORTHLAND DR
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1533
Mailing Address - Country:US
Mailing Address - Phone:330-725-9195
Mailing Address - Fax:
Practice Address - Street 1:246 NORTHLAND DR
Practice Address - Street 2:SUITE 200A
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1533
Practice Address - Country:US
Practice Address - Phone:330-725-9195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 092573164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse