MEDICARE: TYNISHA NICOLE NATION REGISTERED NURSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	22231640	OH

General Provider Information

NPI Number	:	1275059842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYNISHA NICOLE NATION REGISTERED NURSE

Provider Business Mailing Address
First Line	:	6431 OLDE YORK RD
Second Line	:
City	:	PARMA HEIGHTS
State	:	OH
Zip	:	44130-3025
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6431 OLDE YORK
Second Line	:
City	:	PARMA HTS
State	:	OH
Zip	:	44130
Country	:	US
Telephone Number	:	216-612-6713
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2017
Last Update Date	:	03/17/2018

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