Provider Demographics
NPI:1871768036
Name:MAXWELL, TANYA MICHELLE (LPN)
Entity type:Individual
Prefix:MISS
First Name:TANYA
Middle Name:MICHELLE
Last Name:MAXWELL
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 1:1817 BROWNSTONE BLVD
Mailing Address - Street 2:APT. 914
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-6305
Mailing Address - Country:US
Mailing Address - Phone:419-343-5349
Mailing Address - Fax:
Practice Address - Street 1:1817 BROWNSTONE BLVD
Practice Address - Street 2:APT. 914
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-6305
Practice Address - Country:US
Practice Address - Phone:419-343-5349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.088731164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse