Provider Demographics
NPI:1083459267
Name:TONKIN, CASSIDY LEIGH
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:LEIGH
Last Name:TONKIN
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 1:5466 S BUD MILLER RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-8195
Mailing Address - Country:US
Mailing Address - Phone:419-266-9680
Mailing Address - Fax:
Practice Address - Street 1:5466 S BUD MILLER RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-8195
Practice Address - Country:US
Practice Address - Phone:419-266-9680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker