Provider Demographics
NPI:1801964556
Name:SCALLON, TINA TERESA (RN)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:TERESA
Last Name:SCALLON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 FAIRWAY CIR
Mailing Address - Street 2:
Mailing Address - City:PLAIN
Mailing Address - State:WI
Mailing Address - Zip Code:53577-9781
Mailing Address - Country:US
Mailing Address - Phone:608-546-4205
Mailing Address - Fax:
Practice Address - Street 1:915 FAIRWAY CIR
Practice Address - Street 2:
Practice Address - City:PLAIN
Practice Address - State:WI
Practice Address - Zip Code:53577-9781
Practice Address - Country:US
Practice Address - Phone:608-546-4205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse