Provider Demographics
NPI:1154759330
Name:BEACH, DIONNA ROXANE (LPN)
Entity type:Individual
Prefix:
First Name:DIONNA
Middle Name:ROXANE
Last Name:BEACH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S ROBINSON ST
Mailing Address - Street 2:P.O. BOX 14
Mailing Address - City:TIRO
Mailing Address - State:OH
Mailing Address - Zip Code:44887-9625
Mailing Address - Country:US
Mailing Address - Phone:419-565-4494
Mailing Address - Fax:
Practice Address - Street 1:105 S ROBINSON ST
Practice Address - Street 2:
Practice Address - City:TIRO
Practice Address - State:OH
Practice Address - Zip Code:44887-9625
Practice Address - Country:US
Practice Address - Phone:419-565-4494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 126622 M IV164W00000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH74684OtherATN