Provider Demographics
NPI:1831793595
Name:HANSARD, TONYA LYNN
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:LYNN
Last Name:HANSARD
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 1:18705 KILDEER AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-2754
Mailing Address - Country:US
Mailing Address - Phone:216-333-8310
Mailing Address - Fax:
Practice Address - Street 1:18705 KILDEER AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-2754
Practice Address - Country:US
Practice Address - Phone:216-333-8310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0400197Medicaid