Provider Demographics
NPI:1992308423
Name:KUBIAK, TAMI LYNN
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:LYNN
Last Name:KUBIAK
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 1:1601 COUNTY ROAD 1
Mailing Address - Street 2:
Mailing Address - City:LIBERTY CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43532-9620
Mailing Address - Country:US
Mailing Address - Phone:419-266-5916
Mailing Address - Fax:
Practice Address - Street 1:1601 COUNTY ROAD 1
Practice Address - Street 2:
Practice Address - City:LIBERTY CENTER
Practice Address - State:OH
Practice Address - Zip Code:43532-9620
Practice Address - Country:US
Practice Address - Phone:419-266-5916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker