MEDICARE: MS. MELODY LAVONNE TYE STNA

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	376K00000X	Nurse's Aide	400642980707	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528229044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELODY LAVONNE TYE STNA

Provider Business Mailing Address
First Line	:	3470 HARVEY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-2935
Country	:	US
Telephone Number	:	513-381-1344
Fax Number	:	513-381-2607

Provider Business Practice Location Address
First Line	:	3470 HARVEY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-2935
Country	:	US
Telephone Number	:	513-381-1344
Fax Number	:	513-381-2607

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

Provider Enumeration Date	:	06/18/2008
Last Update Date	:	06/18/2008

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