Healthcare Provider Details

I. General information

NPI: 1306511647
Provider Name (Legal Business Name): CECELIA TIREY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 E LIVINGSTON AVE
COLUMBUS OH
43205-2618
US

IV. Provider business mailing address

220 LIBERTY ST APT 10105
COLUMBUS OH
43215-5829
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-8360
  • Fax:
Mailing address:
  • Phone: 740-571-2586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.475721
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: