Provider Demographics
NPI:1447947098
Name:MADISON, TONYA RAE
Entity type:Individual
Prefix:MISS
First Name:TONYA
Middle Name:RAE
Last Name:MADISON
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 1:634 AVONDALE ST
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-3305
Mailing Address - Country:US
Mailing Address - Phone:681-216-5419
Mailing Address - Fax:
Practice Address - Street 1:634 AVONDALE ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-3305
Practice Address - Country:US
Practice Address - Phone:681-216-5419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals