Healthcare Provider Details

I. General information

NPI: 1184034928
Provider Name (Legal Business Name): TANAYA LYNN SYX RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 05/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5173 CADDY RD SW
BOWERSTON OH
44695-9673
US

IV. Provider business mailing address

5173 CADDY RD SW
BOWERSTON OH
44695-9673
US

V. Phone/Fax

Practice location:
  • Phone: 330-735-3198
  • Fax:
Mailing address:
  • Phone: 330-735-3198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.280666
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN.280666
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: