Provider Demographics
NPI:1841495827
Name:RYAN, TIFFANY MARIE (LPN)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:MARIE
Last Name:RYAN
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 1:413 N MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44842-1138
Mailing Address - Country:US
Mailing Address - Phone:419-651-3737
Mailing Address - Fax:
Practice Address - Street 1:413 N MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:OH
Practice Address - Zip Code:44842-1138
Practice Address - Country:US
Practice Address - Phone:419-651-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 118461164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse