Provider Demographics
NPI:1801631510
Name:ANDERSON-SCHULIN, TINA MARIE (RN IBCLC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:ANDERSON-SCHULIN
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4872 LEAVITT RD
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2139
Mailing Address - Country:US
Mailing Address - Phone:440-320-3402
Mailing Address - Fax:
Practice Address - Street 1:4872 LEAVITT RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2139
Practice Address - Country:US
Practice Address - Phone:440-320-3402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH187314163W00000X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse