Provider Demographics
NPI:1316796998
Name:TOMLINSON, RAVEN IOSA (RM, CPM, LM)
Entity type:Individual
Prefix:MS
First Name:RAVEN
Middle Name:IOSA
Last Name:TOMLINSON
Suffix:
Gender:F
Credentials:RM, CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8533 TENON DR APT 5106
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-8094
Mailing Address - Country:US
Mailing Address - Phone:682-336-2186
Mailing Address - Fax:
Practice Address - Street 1:8533 TENON DR APT 5106
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-8094
Practice Address - Country:US
Practice Address - Phone:682-336-2186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99554176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife