Provider Demographics
NPI:1821813064
Name:TUMBLIN, RA'NAE NYRA
Entity type:Individual
Prefix:
First Name:RA'NAE
Middle Name:NYRA
Last Name:TUMBLIN
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 1:1212 MONTGOMERY BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4414
Mailing Address - Country:US
Mailing Address - Phone:504-396-8911
Mailing Address - Fax:
Practice Address - Street 1:1212 MONTGOMERY BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4414
Practice Address - Country:US
Practice Address - Phone:504-396-8911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)