Provider Demographics
NPI:1932231412
Name:HANSEN, TONYA DELORES
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:DELORES
Last Name:HANSEN
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 1:181 MAHOLM ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3831
Mailing Address - Country:US
Mailing Address - Phone:740-344-0404
Mailing Address - Fax:
Practice Address - Street 1:181 MAHOLM ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3831
Practice Address - Country:US
Practice Address - Phone:740-344-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2433316Medicaid