Provider Demographics
NPI:1871894667
Name:SHEARER, TINA MARIE (RN)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:SHEARER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-2853
Mailing Address - Country:US
Mailing Address - Phone:937-360-0099
Mailing Address - Fax:
Practice Address - Street 1:120 DOUGLAS DR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-2853
Practice Address - Country:US
Practice Address - Phone:937-360-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN247021163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse