Provider Demographics
NPI:1801292347
Name:ADAMS, TONYA RENAE (LPN)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:RENAE
Last Name:ADAMS
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 1:2027 WILLOWOOD DR N
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1763
Mailing Address - Country:US
Mailing Address - Phone:419-512-2874
Mailing Address - Fax:
Practice Address - Street 1:2027 WILLOWOOD DR N
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-1763
Practice Address - Country:US
Practice Address - Phone:419-512-2874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.120188-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse