Provider Demographics
NPI:1427324219
Name:ELEY, TONYETTA
Entity type:Individual
Prefix:
First Name:TONYETTA
Middle Name:
Last Name:ELEY
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 1:9819 BITTER END CV
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-9649
Mailing Address - Country:US
Mailing Address - Phone:260-418-3543
Mailing Address - Fax:
Practice Address - Street 1:9819 BITTER END CV
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-9649
Practice Address - Country:US
Practice Address - Phone:260-418-3543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201043590 AMedicaid